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Effect of hydrotherapy in the Effect of hydrotherapy in the rehabilitative treatment of rehabilitative treatment of
Multiple Sclerosis (MS)Multiple Sclerosis (MS)
Volanti P, Scialabba G, De Cicco D.Volanti P, Scialabba G, De Cicco D.
Neurorehabilitation UnitNeurorehabilitation Unit
Fondazione Salvatore Maugeri, IRCCSFondazione Salvatore Maugeri, IRCCS
P.O. “SS. Salvatore” – Mistretta (ME) P.O. “SS. Salvatore” – Mistretta (ME) May 25, 2010
Background
Despite major advances in MS care and disease modifying therapies, no longer term benefit on disability has yet been demonstrated The supportive and
symptomatic management provided by multidisciplinary rehabilitation programmes remain the mainstay of treatment
Aim of the study
To evaluate and compare the efficacy of conventional physiotherapy and hydrotherapy on impairment, disability, and quality of life of MS patients
Materials and Methods-1
Sixty patients affected by secondary progressive
MS with mild to moderate disability (Expanded
Disability Status Scale–EDSS scores≤6.5), referred
to our Neurorehabilitation Unit, were randomly
assigned to two groups, and matched for age,
gender, EDSS and Functional Indipendence
Mesaure (FIM) scores
Materials and Methods-2
The Control Group (n=28)
received conventional
physiotherapy twice a day,
five times per week, for 2
consecutive months
The Hydrotherapy Group
(n=32) also received
conventional physiotherapy,
as well as 45 min of water
exercises (at 32 C) 3 times
per week, for 2 consecutive
months
Materials and Methods-3
Primary outcomes
Impairment and disability (EDSS
and FIM scores)
Quality of life (McGill Qol-SIS)
Secondary outcomes
Spasticity (Ashwort scale)
Pain (Visual Analogue Scale, VAS)
Fatigue (Fatigue Severity Scale,
FSS)
10-mt walking time (sec) Muscle strength (manual muscular
test, MMT)
Respiratory function (spirometric
parameters)
At baseline, and at the end of the rehabilitative treatment, were evaluated:
Table 1. Demographic and clinical characteristics of
groups at baseline
Control Group (n=28) Hydrotherapy Group (n=32) p
Age (years) 41,5 ± 8,7 45 ± 6,6 ns
Sex (M/F) 15/13 16/16 ns
EDSS (0-10) 6,3 ± 0,2 6,2 ± 0,2 ns
FIMTotal score (18-128)Motor score
83,4 ± 12,555,4 ± 13,9
85,7 ± 9,456,6 ± 9,8
ns
Ashwort score (ASH, 0-4) 1,7 ± 1,1 1,8 ± 1,2 ns
Pain (VAS, 0-10) 4.8 ± 1 5 ± 0,9 ns
Fatigue (FSS,1-7) 5,1 ± 0,6 5,2 ± 0,7 ns
10-mt walking time (sec) 17,3 ± 5,1 19,2 ± 7,9 ns
Muscle Strenght (MMT)AASS (0-70)AAII (0-70)
66,7 ± 5,3
56,5 ± 11,5
66,3 ± 4,8
58,7 ± 10,1ns
FVC (%) 97 ± 6,9 101 ± 13,2 ns
Quality of life (McGill QoL-SIS) 5,7 ± 1,1 5,4 ± 1,4 ns
Results-1 FIM scores
18
36
54
72
90
108
126
Before After
Control Group
HydrotherapyGroup
FIM scores before
treatment
FIM scores after
treatmentp
Control Group 83,4 ± 12,5 93,6 ± 15,4 <0,001
Hydrotherapy Group
85,7 ± 9,4 99,8 ± 10,8 <0,001
p ns <0,05
At the end of the 2 months of
rehabilitative treatment, the
Hydrotherapy Group improved
significantly in disability, as
assessed by the Functional
Independence Measure (FIM)
scores, compared to the Control
Group
FIM scores
p=ns
p<0,05
Results-2 EDSS scores
0
2
4
6
8
10
Before After
ControlGroup
0
2
4
6
8
10
Before After
HydrotherapyGroup
At the end of the two months of treatment, no significantly changes in EDSS scores were reported in the two groups
p=ns p=ns
EDSS EDSS
Results-3 Quality of life (McGill Qol-SIS)
0123456789
10
Before After
ControlGroupHydrotherapyGroup
MQoL-SIS
before treatment
MQol-SIS
after treatment
p
Control Group 5,7 ± 1,1 6,1 ± 1,4 ns
Hydrotherapy Group
5,4 ± 1,4 6,8 ± 1,5 p<0.05
At the end of the two months of treatment, only the Hydrotherapy Group improved significantly in quality of life
MQOL-SIS
Results-4 Secondary outcomes
0
1
2
3
4
Before After
Control Group
HydrotherapyGroup
0
2
4
6
8
10
Before After
Control Group
HydrotherapyGroup
At the end of the two months of treatment, the Hydrotherapy Group also showed a larger improvement on spasticity (Ashwort score) and pain (VAS), compared to the Control Group.
No statistical differences were reported in other secondary outcomes (fatigue, muscle strength, 10-mt walking time, respiratory function), for both control and hydrotherapy group
Ashwort score before and after treatment
VAS scores for pain before and after treatment
p=nsp=ns
p<0.05p<0.05
Conclusions
Adding hydrotherapy to the conventional Adding hydrotherapy to the conventional
physiotherapy program improve function and physiotherapy program improve function and
quality of life, and reduce spasticity and pain, quality of life, and reduce spasticity and pain,
in patients affected by secondary progressive in patients affected by secondary progressive
multiple sclerosis with mild to moderate multiple sclerosis with mild to moderate
disabilitydisability
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