Study of the effectiveness of hydrokinesiotherapy in physiotherapy rehabilitation of patients with hemiplegia (Master thesis)

Ιατρίδου, Γεωργία Γ.

Objective: The purpose of this current study is a) to summarize evidence from previously published studies on the effects of hydrokinesiotherapy (HT) on postural balance in hemiplegic patients after stroke and compare them with conventional land therapy and b) to assess and compare the effects of a hydrokinesiotherapy programme against a conventional land-based exercise programme in individuals with hemiplegia. Methods: In the meta-analysis, a literature search until October 2017 was conducted on CINAHL, PubMed, Cochrane EBM Reviews, Cochrane Clinical Trials, DARE, MEDLINE, Physiotherapy Evidence Database (PEDro), PsycInfo and Rehabilitation and Sports Medicine Source. Only randomized controlled trials with pre-intervention and post-intervention assessment on postural control have been included. In the clinical study, a double-blind randomized controlled study of chronic stroke patients with hemiplegia, were undertaken. Participants were randomized to the hydrotherapy (water-based exercises) or conventional therapy (land-based exercises) groups. Both groups attended therapy three times per week for six weeks. Both exercise interventions aimed at improving posture, balance and weight-bearing capability. Outcomes included the Berg Balance Score, Brunnstrom scale, Motricity Index, muscle tests, Modified Ashworth Scale, PASS, TCT and FIM. Also, postural sway was evaluated with a pressure platform by using the variables of center of pressure (COP) displacements. Results: A total of 11 trials on postural control with 305 mixed subacute (6weeks - 6 months time from incident) or chronic (> 6 months time from incident) stroke patients were included. The majority of studies showed a beneficial effect of HT in postural control of the patients. The meta-analysis showed statistically significant improvement (p< 0.05) in Berg Balance Scale (BBS), mediolateral (ML) and anteroposterior (AP) sway velocity of center of pressure with eyes closed in both groups, but the mean differences were statistically improved (p< 0.05) in patients exercising with HT over land therapy program. In the clinical study, 51 chronic stroke patients were recruited. The conventional therapy group (26 patients) attained significant improvements (p<0,05) over the hydrotherapy group (25 patients) in paretic lower extremity muscle strength, spasticity, postural control, trunk control and functional independence. Also, compared with the hydrotherapy group, the conventional therapy group achieved significant improvements (p<0,05) in anteroposterior deviation of COP, in mediolateral COP velocity and in total COP velocity in sitting position with eyes closed. There were no significant changes in the other measurements between the two groups. In conclusion, our literature synthesis showed that HT is superior to land therapy program regarding postural balance in subacute or chronic stroke patients. On the contrary, there were no significant changes in postural balance (BBS) between the two groups of therapy within our clinical study. Furthermore, land-based exercises were more effective and beneficial than water-based exercises in strength, spasticity, postural control, trunk control and functional status of chronic stroke patients.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Ημιπληγία -- Αποκατάσταση
Keywords: Υδροκινησιοθεραπεία,Ημιπληγία,Αγγειακό εγκεφαλικό επεισόδιο,Hydrokinesiotherapy,Hemiplegia,Stroke
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