The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson's Disease: A single blind pilot trial

Abstract

Background There is growing evidence that aquatic physiotherapy may be effective for people with Parkinson's Disease (PD) but most studies have investigated land based type exercises in the aquatic environment. Few studies have examined customised aquatic therapies such as the Halliwick concept which focuses on trunk rotation and core stabilisation. Objective The primary aim was to determine the feasibility of a Halliwick style aquatic physiotherapy intervention for people with PD. The secondary aim was to compare the Halliwick intervention with traditional aquatic and land based physiotherapy in terms of disease severity, balance and fear of falling. Methods Halliwick style aquatic, traditional aquatic and land based physiotherapy were trialled in a single blind pilot study. All interventions ran for 60 minutes per week over 12 weeks. Feasibility outcomes were safety, adherence and attrition. Secondary outcomes included the Unified Parkinson's Disease Rating Scale motor subsection (UPDRS-III), Berg Balance Scale (BBS), Mini BESTest and modified Falls Efficacy Scale (mFES). Results 30 participants with moderate PD were recruited. Participant mean age was 72 years (SD 8.4; range 51-86) with moderate disease severity (median Hoehn & Yahr score 3; IQR 1). No falls occurred during intervention sessions, however ten participants reported falls during the study period. No other adverse consequences were reported. All groups had adherence over 85%. No within group significant differences were found in UPDRS-III, BBS or mFES

Perceptions of aquatic physiotherapy and health‐related quality of life among people with Parkinson’s disease

“…The results of our focus groups indicate that the majority of participants felt safe in the aquatic environment ; therefore, this treatment modality may be more acceptable for the PD population. This adds to previous literature which has shown that aquatic physiotherapy is a safe and feasible treatment option 12 . Although participants felt that aquatic physiotherapy resulted in improvements in balance and general function, they identified that changing from wet swimwear after the class was a barrier.…”

“…This was a concurrent nested study within a previous single‐blind pilot trial (Figure 1) that examined the feasibility of a Halliwick concept style aquatic therapy programme for people with PD 12 . Phase 1 gathered information via a survey regarding participant experiences with an aquatic physiotherapy programme.…”

“…Individuals who completed the aquatic programme were invited to participate in this study. The sample and sampling procedures for the pilot trial have been described in detail elsewhere 12 . In brief, participants were required to have a diagnosis of idiopathic PD confirmed by a neurologist, transfer and walk without assistance with or without gait aid (as clients are required to independently transfer in and out of the pool via steps), and have a Mini‐Mental State Examination (MMSE) score of 24 or above so that they can follow instructions.…”

“…Although exercise has been seen to have a positive effect on falls and HRQoL, 9 research has indicated that common barriers such as lack of time, fear of falling and low outcome expectation are perceived in community dwelling individuals with PD 9 . Previous research has also shown that participation in exercise programmes is low in people with PD 10‐12 …”

The effects of aquatic therapy during post-acute neurorehabilitation in patients with severe traumatic brain injury: a preliminary randomized controlled trial

“…Furthermore, safety was also assessed by the absence or occurrence of side effects identified or witnessed by either the patient or clinical staff during and after the intervention sessions. This included falls during the intervention sessions and the intervention period, chlorine allergies, and pain (43).…”