Zivi I, Maffia S, Ferrari V, et al. Effectiveness of aquatic versus land physiotherapy in the treatment of peripheral neuropathies: a randomized controlled trial. Clin Rehabil. 2017 Dec 1:269215517746716. doi: 10.1177/0269215517746716.
Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7

OBJECTIVE: To compare the effects on gait and balance of aquatic physiotherapy versus on-land training, in the context of an inpatient rehabilitation treatment tailored for peripheral neuropathies.

DESIGN: Parallel-group, single-center, single-blind randomized controlled trial.

SUBJECTS AND SETTING: Consecutive patients affected by peripheral neuropathy admitted in our Neuro-Rehabilitation Unit.

INTERVENTIONS: Patients received a four-week rehabilitation program composed by daily sessions of conventional physiotherapy and three sessions/week of specific treatment (aquatic vs. on-land).

MAIN MEASURES: Primary outcome measures were Berg Balance Scale and Dynamic Gait Index. Secondary outcome measures were Neuropathic Pain Scale, Overall Neuropathy Limitations Scale, Functional Independence Measure, Functional Ambulation Classification, Conley Scale and Medical Research Council Scale score for the strength of hip and ankle flexor and extensor muscles. For each scale, we calculated the difference between the scores at discharge and admission and compared it between the two groups.

RESULTS: Forty patients were enrolled: 21 in the water-based rehabilitation group and 19 in the land-based one. Patients were similar between groups. When comparing the groups, we found that "in-water" patients had a significant better improvement in the Dynamic Gait Index score (6.00 (4.00, 7.25) vs. 4.00 (1.25, 6.00), P = 0.0433). On the opposite, the "on-land" group showed a better improvement of the Functional Ambulation Classification score (1.0 (0.75, 1.0) vs. 1.0 (1.0, 2.0), P = 0.0386).

CONCLUSION: Aquatic physiotherapy showed an effect comparable to the land-based rehabilitation on gait and balance dysfunctions of neuropathic patients.

Comments from MORE raters

Physician rater

The setting was inpatient rehab for neuropathy, which would be uncommon in North America, so applicability of this trial is limited. It's reassuring that there was overall little difference between water and land based therapy for this population. Physical therapy did seem to have an effect, which is reassuring. My take-away is that when patients ask whether water therapy is preferred for therapy, I would advise them 'probably not if it is less convenient for you to get to the facility.'

Rehab Clinician (OT/PT) rater

Very small sample (high risk of erroneous results); results may have differed if it had been a larger sample. As is, we are left to rationalise why 2 different mobility assessment scores provided contradictory results.
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