Effectiveness and efficiency of aquatic therapy on independence in activities of daily living and mobility in post-acute spinal cord injury: A matched case-control study.

IF 1.5 Q3 REHABILITATION Physiotherapy Research International Pub Date : 2024-10-01 DOI:10.1002/pri.2141
Alejandro García-Rudolph, Jordi Finestres, Mark Andrew Wright, Josep Medina Casanovas, Eloy Opisso
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Abstract

Background and purpose: Aquatic therapy (AT), though potentially effective, lacks studies on clinical efficacy in patients with spinal cord injury (SCI). A recent study analyzing interviews with rehabilitation professionals on its clinical application reported that the scarce evidence of AT benefits was one of the actual barriers to its successful integration into clinical practice. We seek to provide evidence by comparing independence in activities of daily living (ADLs) and functional ambulation capacity in patients following rehabilitation which included AT and matched controls who followed rehabilitation without AT (non-AT).

Methods: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM-III), Walking Index for Spinal Cord Injury (WISCI-II) and its minimal clinically important difference (WISCI-II/MCID) were assessed. The AT group followed the Halliwick concept. We performed nonparametric nearest-neighbor k:1 matching for age, time since injury to admission, FIM at admission, level of injury (paraplegia/tetraplegia), completeness and cause of injury (traumatic, non-traumatic). The rehabilitation program comprised four daily hours of intensive treatment from the multidisciplinary team. Both groups received the same total number of rehabilitation hours at the same specialized clinical center and were admitted to follow inpatient rehabilitation within 2 months after injury.

Results: A total of 29 patients with SCI who followed AT (admitted between 2017 and 2023) were compared to historical matches selected from 551 inpatients with SCI (admitted between 2014 and 2023). For k = 1, the groups showed no significant differences in gains, efficiency, or effectiveness in FIM and SCIM-III; significant differences were observed in WISCI-II gain (p = 0.018) and WISCI-II efficiency (p = 0.046) in favor of the AT group; the proportion of patients achieving WISCI-II/MCID was significantly higher for the AT group (75.9% vs. 48.3%) (p = 0.030). These results were confirmed for k = 2.

Conclusion: The AT group performed similarly in independence for performing ADLs and significantly better in ambulation than the matched historical controls.

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水疗对急性脊髓损伤后日常生活自理能力和活动能力的效果和效率:一项匹配病例对照研究。
背景和目的:水疗(AT)虽然可能有效,但缺乏对脊髓损伤(SCI)患者临床疗效的研究。最近的一项研究分析了与康复专业人员就水疗的临床应用进行的访谈,结果表明,缺乏有关水疗益处的证据是阻碍水疗成功融入临床实践的实际障碍之一。我们试图通过比较接受包括辅助器具在内的康复治疗的患者和接受无辅助器具康复治疗(非辅助器具)的匹配对照组在日常生活活动(ADLs)中的独立性和功能性行走能力来提供证据:方法:评估功能独立性测量(FIM)、脊髓独立性测量(SCIM-III)、脊髓损伤步行指数(WISCI-II)及其最小临床意义差异(WISCI-II/MCID)。AT 组遵循 Halliwick 概念。我们对年龄、受伤后到入院的时间、入院时的 FIM、受伤程度(截瘫/四肢瘫痪)、完整性和受伤原因(创伤性、非创伤性)进行了非参数近邻 k:1 匹配。康复计划包括多学科团队每天四小时的强化治疗。两组患者在同一专科临床中心接受的康复治疗总时数相同,并在伤后两个月内接受住院康复治疗:研究人员将从 551 名 SCI 住院患者(2014 年至 2023 年间入院)中挑选出的 29 名接受 AT 治疗的 SCI 患者(2017 年至 2023 年间入院)与历史配对患者进行了比较。对于 k = 1,两组在 FIM 和 SCIM-III 的收益、效率或有效性方面没有显著差异;在 WISCI-II 的收益(p = 0.018)和 WISCI-II 的效率(p = 0.046)方面观察到显著差异,AT 组更胜一筹;AT 组达到 WISCI-II/MCID 的患者比例显著更高(75.9% 对 48.3%)(p = 0.030)。这些结果在 k = 2.结论中得到了证实:AT组患者在日常生活自理能力方面的表现类似,而在行走能力方面则明显优于匹配的历史对照组。
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来源期刊
CiteScore
3.30
自引率
5.90%
发文量
53
期刊介绍: Physiotherapy Research International is an international peer reviewed journal dedicated to the exchange of knowledge that is directly relevant to specialist areas of physiotherapy theory, practice, and research. Our aim is to promote a high level of scholarship and build on the current evidence base to inform the advancement of the physiotherapy profession. We publish original research on a wide range of topics e.g. Primary research testing new physiotherapy treatments; methodological research; measurement and outcome research and qualitative research of interest to researchers, clinicians and educators. Further, we aim to publish high quality papers that represent the range of cultures and settings where physiotherapy services are delivered. We attract a wide readership from physiotherapists and others working in diverse clinical and academic settings. We aim to promote an international debate amongst the profession about current best evidence based practice. Papers are directed primarily towards the physiotherapy profession, but can be relevant to a wide range of professional groups. The growth of interdisciplinary research is also key to our aims and scope, and we encourage relevant submissions from other professional groups. The journal actively encourages submissions which utilise a breadth of different methodologies and research designs to facilitate addressing key questions related to the physiotherapy practice. PRI seeks to encourage good quality topical debates on a range of relevant issues and promote critical reflection on decision making and implementation of physiotherapy interventions.
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