Date of Award

5-1-2023

Degree Type

DPT Project

Degree Name

Doctor of Physical Therapy (DPT)

Advisor

Balachandar Kathirvelu

Abstract

Introduction. Cerebral vascular accidents (CVA), or stroke, can lead to impairments in strength, range of motion (ROM), balance, cognition, sensory integrity, and motor function. These several impairments all contribute to a decline in dynamic and static balance among stroke patients. Traditional rehabilitation for stroke involves land-based therapy (LB) techniques addressing impairments within each individual patient. Aquatic therapy (AQ) has also been utilized for rehabilitation in stroke and has been found to be beneficial among stroke patients. The purpose of this Systematic Review (SR) is to compare the effect of AQ and LB therapies on balance and gait. The rehabilitation programs consisted of neuromuscular and strength training.

Methods. The Databases searched included PubMed, Web of Science, PEDro, SAGE journals and Ebsco (Figure 1). We included Randomized Control Trials (RCTs) that compared LB with AQ therapy, or a combination of the two, on post-stroke patients. The main outcomes assessed include dynamic balance, static balance, and gait. We assessed the risk for bias using the PEDro Scale.

Results. A total of 10 RCTs were included in the analysis. For gait and balance, limited evidence was found showing that AQ can be used as an alternative to LB in the short-term. Most of the studies showed significant improvement from baseline when using aquatic therapy. However, in most studies no significant difference was found between the control and the intervention groups post-treatment.

Discussion. This SR suggests that AQ alone, or AQ+LB for post-stroke rehabilitation is adequate and effective in improving gait, static and dynamic balance in the short-term. Improvements in the within-group analysis were found in each article for at least one balance and gait outcome measure. Although improvements were found post-treatment, no group is superior when compared between each other. Rehabilitation plan of care should consist of two sessions per week for 4-to-8 weeks.

Limitations. Some of the limitations of this SR include: small sample size on the articles analyzed, reliance on outcome measures and heterogeneity of the studies.

Conclusion: This SR supports the use of Aquatic alone or in combination with Land-based in post-stroke rehabilitation since it proved to be an effective treatment approach for improving balance and gait. Future research should implement consistent methodology and follow up with long term outcomes to be able to extract more long-term conclusions.

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