The efficacy and feasibility of aquatic physiotherapy for people with Parkinson’s disease: a systematic review

Abstract

Aquatic physiotherapy may improve aspects of motor performance, quality of life and balance in people with Parkinson's disease, however, it remains unclear whether it is a safe and feasible treatment modality. The development of standardised outcome measures for people with Parkinson's disease (unified Parkinson's disease rating scale and Parkinson's disease questionnaire-39) would aid study comparability and validate study outcomes. As safety criteria was grossly underreported, guidelines for mandatory reporting of safety criteria are essential to make conclusions regarding the feasibility of aquatic physiotherapy for people with Parkinson's disease. Implications for Rehabilitation Aquatic physiotherapy may be a beneficial treatment modality for people with Parkinson's disease. A minimum data set that includes the unified Parkinson's disease rating scale and Parkinson's disease questionnaire 39 is required to aid future meta-analysis and to allow more definitive conclusions to be made regarding aquatic physiotherapy for people with Parkinson's disease. People with Parkinson's disease are a vulnerable population, where safety within an aquatic physiotherapy program needs to be well documented and addressed.

Is Aquatic Therapy Optimally Prescribed for Parkinson’s Disease? A Systematic Review and Meta-Analysis

“…However, these improvements were less than the minimal detectable change (MDC) score of 3.5 seconds reported for the TUG in people with PD [72]. Arguably, a lack of targeted aquatic exercise interventions for specific movement disorders in PD may have limited the effects of aquatic therapy.This meta-analysis adds to previous reports,[37][38][39]73] with some new insights gained. A previous review by Methajarunon et al[73] was unable to draw firm conclusions as it only included two trials with small sample sizes.…”

“…[42] Both tools have reported reliability and validity, and have been used to appraise RCTs in previous systematic reviews. [38,41,43,44…”

“…[33][34][35] More recently, cytokine modulation was observed to facilitate immune responses in people living with PD, with short-term and longterm benefits observed following aquatic therapy. [36] Preliminary literature reviews of mainly non-randomized controlled trials [37][38][39] reported that aquatic therapy may improve postural stability, motor function and gait in the early stages of PD. These reviews did not always report key elements such as the water temperature, water depth, accessibility of therapy, patient involvement in the treatment protocol design, location of pre-post assessments (in water or over-land), follow-up retention of aquatic therapy benefits, or the costs of aquatic therapy.…”

“…A previous review by Methajarunon et al[73] was unable to draw firm conclusions as it only included two trials with small sample sizes. Another analysed within group effects only and included non-randomized trials [38]. Our analysis is based on raw data from seven randomized controlled trials and a total of 209 participants.…”

The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta‐analysis

“…Seventeen studies used the Hoehn and Yahr (HY) clinical rating scale. Twelve studies presented the results as mean (between 1.88 and 3.1) and five studies presented results as frequencies (ranging from 1 to 4) . The characteristics of the studies are listed in Table .…”