Effects of aquatic physiotherapy versus conventional physical therapy on the risk of fall in the elderly: a randomized clinical trial

Abstract

Objective: To identify whether physiotherapy treatment in water is more effective than the treatment in land environment, aiming at improving the process of physical limitation or functional inability (gait speed, balance, motor abilities) caused by lack of balance in elderly with risk of fall. Methods: Randomized clinical trial, experimental study. The sample was composed of 35 senior individuals of both sexes, with average age of 65. Nineteen people composed the control Group /Conventional Physiotherapy, while the rest composed the experimental Group/Aquatic Physical therapy. Both groups were submitted to twenty sessions of physical therapy, twice a week, for 50 minutes in individual treatment. Aerobic activities were conducted for both groups separately. Exercises using water specific therapy, such as Halliwick rotation control and Bad Ragaz ring method, were used in the aquatic group and in the conventional group, physiotherapeutic techniques were applied, approaching the concepts of proprioceptive neuromuscular facilitation (PNF) and decubitus change training. The following tests were used to measure the risk of fall/balance: Timed Up and Go Test, Sit-to-Stand in 30 seconds and Functional Reach. Results: Both physiotherapeutic interventions, aquatic and conventional, showed to be greatly efficient however aquatic physiotherapy showed certain advantages compared to conventional physical therapy, promoting more beneficial effects in the gait speed, balance, motor abilities and, mainly, in the reduction of the risk of fall.Keywords: elderly, Halliwick, Bad Ragaz, Physical therapy, aquatic, risk of fall.

Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis

“…After duplicate articles were removed, 2039 articles remained for analysis of titles and abstracts, 33 of which were read in their entirety. After reading, 11 trials [21][22][23][24][25][26][27][28][29][30][31] were considered eligible for the present review, nine of which are randomized [21,23,[25][26][27][28][29][30][31] and two quasi-randomized [22,24]. Of the excluded articles, eleven contained only the intervention group [14,[32][33][34][35][36][37][38][39][40][41], six trials included volunteers with neurological and/or orthopedic diseases in their samples [42][43][44][45][46][47], three had individuals younger than 60 years [15,16,48], one trial included older adults that using walking aids device [49], and one was a cross-sectional study [13].…”

“…All eleven trials used aquatic physical therapy exercises for the intervention group and the control group was submitted in eight trials to land-based physical therapy exercises [21,23,24,[26][27][28][29][30]. In three trials, the control group did not engage in exercises [22,23,31] and Elbar et al [25] conducted a crossover trial, where the intervention group started with aquatic physical therapy exercises and the control group performed none, reversing the interventions after 12 weeks.…”

“…Nine of the eleven eligible trials mentioned randomization; however, only five [25][26][27][28]30] clearly described how this process took place. Two trials [22,24] exhibited high risk of bias, since they only reported that the sample was divided into control and intervention groups.…”

“…Only four of the trials used allocation concealment, via opaque envelopes [25,26,28,30], while seven made no mention of this procedure, indicating high risk of bias.…”

“…Sample losses occurred in nine of the eleven trials; however, none of these conducted intention-to-treat analysis. One of the studies contained a selective description of the outcome, indicating high risk of bias for those with sample losses that did not carry out intention-totreat analysis [21,[23][24][25][26][27][28][29]31] and Cunha et al [23] selectively described the outcome data.…”