I

I Research Report :

iRS HI~n rna n, BIPh~s'io(Hons)~ PihlD, iDs, LectIJlU~lr~, Centre 'fOlf' Hleal'th Ex.ercise and SIi!'Orts Mledi(jnle~ llni-

." ~-'M lb M lb

:-."-:.::. -: .... - 1:-" :. ,"1 "-1 - --.: ~ : -. - ..... - -- _', I

vers~,ty OJ""€!"ourne,_@ . OUr~,E!1

V· .. ' AC- t 0'-' r=li'I':ii1 A"' I~ i Ii! tra -1·1 ~I .iI'. .oJ d· IFloe,j[: .,., ~ ~ II!"',#';.IIF'_

',_: 1.'_ c _ 1IItJl, .: ~~~L 'al ~,. lMU, _ 'Ii;.~~~ U,' ~V~I

re-sponde nee' ~,o ID~r Hi nma nail:: rana sh@"JIif'I~im el: b.edu .,(1 U"

S E H-e)llNoodil, B P'hy,sil:o (H'O'",S}I' M IPhySi~O ($IPO rts), C:eirt Myel roth er,i3!PY" is Senior ,Aq1ua,tic Ph",:5i,o't1her-, ,8lpi1st" Plhys,iolther,a,py [)e pa rtment, Sunshin D biO,lr"p····I't"· ~I and IP~\i~·I'O~'

..J .~' ,,~II I " ~ n·· ,~ .. .ii;l1 I! ~ !jJ! - I~ 11.1 oii!', .'

thera pist, Me~ bou rne SIPO rts M ediei ne Centre, ~'''h?llbo u rne, Vi,e torl a, Auslral'ia.,

AR Day" IBAplpSci~(HUlm!an Mo~e\mlenl).· - BAlnp.-: S~cil(··.· Phusio)" MS "om

--- --I t". -- --,l-~ "" -I"'" " ,

Physio;.- is IPrineipa~1 Phys'iotlle{f,ap,isit

IlPro[alre IPhys~,otherapy~ Newport,

~Ind' I IPhv~;',A~ir\Qr~[ni'..:;t "I S·,·,-I S·::·· -po r-~m::: ~ ';!Ii m

Q_ - - - - .; ,,~UI~!II,~'_ ~~'-~ -, ~I. -- ~!,l

C:':;!jj[II",1t'l; A" I't,nn-::JIJ "~QGIIld( If'VIoA"'~" M"-'Dlb-.·oi"'ii'~Jmi~

Y I! '!!;;:". !1J' g ~IV~ 'l;;i!iiI! V'!Il''!I!',,;)I~, . ![;; . '!J Ij" _ r;;;;,.

'Vi\Ctorhl~ A!lJJstraUiI' ~

I[H'i'nman R.S, H!@~ood SIE" Day A'R., A,qlua'tilc pl~ys'i(,a I th era py 'for hip and knee osteoa rth rl tis': resuliJ'ts. ,ofl' a S,I ngli e-bl i nd ra ndom i zed cfJn~ml~ed 'triat Phys; 'Tiler;, 200:7; ,8,7: 32-·4, 3,.],

@ 2007' Almlerh:a n If'biysilcztlll 'Thlerapy As5!ociation

For The Bottom LJjine,:: www .. ptjo.U.mtll~.0r9

Aquatic II yslca . rerapy fo= Hl .• ~ .... and Knee Osteoarthritis:

Results of a Sir iqle Bllrn ,B.ndomize,'- Controlled Trle

Baclk.'gl'ro,ulnd and Purpose

Aquatic plly~:,:~.'ca'~ thl=,r~,l,'py' is, frequently used in the managr ment of patient 50 with hip and knee 10"", teoarthritts (01, : )l' yet there is little reses rch es ,a'bU.,hing :nt.,;, 'Iica,c)r for

thls po ;-:ul~jl'[ioin ~ The purpose physical therapy Din, hip or klll e I ,A.

f ' .,

,j t~_,1.tS

S,u1b,ject.s

A, IU)ir.t~'1 of' I ] volunte ers with symptomatic :hjm~A 10£ kn \, 1._.-:_ participated in, this

sn 'ilid \l'

~ _:_'l!JI!j ~- llJ ,!!!,

TIl' study was .. ",Ie'"-i~n,ed, 'I _'. a 1r3.'n,d .. omized controlled [ri:aJ in>' hich partktpants Fan.' (linlJl" receiv ::--d 6! \1\1' eks I. f a,([tI13,'U,C phystcal '[h"e'fll.p'l er no ~l,'qual~~' p,h)J\J,[.""td therapy. Or tC[;U'll1.1 measures iml ]ud: d ,P(31iJI1. physical functic II.., physica a ._,t'i, i~l' levels, q'U.aUl" of liife l' and mus cle ~ tre ngth,

IRe,5ullts,

The intervention r suited :in l.~~ p,~~.hl. an.d jOIi:'f'nJ[ ,tiLffne;-, and grear .'f pl Y' l!':,d function. I uality of ~jfi. 'j and 11 i P m U' '\ 1. "' .. It ren _.lh '. T· tals of 72% a nd ~""IC~ of p{" rticipann '.' r, ported improv . J11 nts fn pain a.n.d function, respectively, ... ,IID.,pia:red wi'b, only , 7%1

(. ach) Olt conrrol parrtciparn - •.. B nefits 'wier"'" rnaintained e w '. ks after rhe compt ..

'j,on at :ph}1~~,'C3J therapy "f::t'h, ,,' ,-'''I of' P~:U"'lilc'i:p~Ul'ts connnuing iLn.d pendently.

Dlscusslon and Conclusion

I ompared with no huervenrlon, a '&:we.·. k pro J7tOl of aquatic physical therapy resulted in significantly ~es: p,~d n ~~ nd in". "fO.· '_ d. physic (~ funcri on, sr - -l th, and '(],l 'a U, ty if' hfe, I"~ '~," unclear whether the bcnema were artributable '[10 ,~n', nr nttoo

~,~f.': ct Of- "l' 'iii)' m. ."0,. iif'.':-'·.·'iI!) •. O·ill'l' ' .. j' .. '.

~_JjJllh ." "I~... I ".' l~L, l' ,Wl' ..' .' . ~; ." JIj," . II . l.

· steoarthritis (O.A) is '00- of the most prevalent mUSrCldOB'

...... .,. r '.',. I·· tal condition s affecting

rhe elderly populaticn worldwide.' and, its prevalence is predicted 'to rise significanti in the future as th population ages .. :2 Knee ·0.1\ currently affects about 40% of people aged over '75 Y'efUY, and 'hip IDA affects about ]0%.,3 Peoph with IDA frequemly report [oint pain, stiffness, loss of physical function l' increasing Immobility, and muscle weakness, '-·U,C'1. signs an.d. symptoms of th .. e disease often culminate in red " ictions in, quality of life. Contemporary managemen t of' OA, urns to allevia te 1):3101 and dis'abmli:ty' while avoiding adverse effects of therapy." Current guidelines recor imend nonpharmacologtc methods, such. as physical therapy, as first -llne options in the managem ' en 0';; a"'A' 5 Physi .... \.,.., 1 t 11~r~ 'p·t; fo r

u :~ I _ ", •• ..IL < ... :': ",fII .- .!l),~ d!l'!L.r.ldli . Jl .,,,-= ~ . ,j .1'., . 1,1 •

OA, may' be provided 0,:0 land or in. an aquatf ',; e1l1,VU'Ol1'm,en'L

,~·'tlyd·roth.e.ra.py'~ is a term encompassing a. range of therapeutic and

~ t-" "'t'" iii d t··

exercise ~1.C'~1 V' es carne .,' , QU., :111

heated 1).0 01" bY' a varlet .. ' of providers. Ex.:perts rate hydrotherapy as

ftl . .' .. f'3', .0 .~.~

one 0.:, '[ lie . eas'[ toXiC o. '. ':., :po'£etltla.

t .. ,.~ ... ·t' . ",&of ·t'ifii "'n" knee 0" 'A- 6, A-·· q' -t atic

rle".~I_,m'\".n _;i,}!l lui" _2:,n!!l;.,.-_ .•. :_' ."' .:_.: . _ ,U~u..L ,

'Jltysica[ 'th,'f'ca:Pf in,corporat'es ind .. i· .. ,

v,'!! d'u, "'l'1 .;;:I1ij;:'ij;:' ~!i2'~n'l~'n' ··it ~'!iI·l'll",d' ;.:<!i'nc",ifiii',-:b;"1I s· . , (.

_ ' .,' lAoi ~!Ilu'~II~!iI;r"~~ ~ .~.1I!i.r. lL,- ~ ~, ... ~ ,.". ~ .. \"'1";·" .". ,

p:ractice' 3.nd .clinj"C'.al.re~aso.nlng s. ,iUs

'Ii"o ,d-" 'iiI.;i"~~. iI'Iii"',~a'Fn-'lpn,;r- p"'-~'Flll;1, ·b'.a·P-ld. '0'111

I.., . 'f ,1Ii,iJI!' II.J! """.... ,II!;".. " .,' ,"".I., ,'!.1i' , .' ". ,._.. ,_' "'~"

t'l-l"- p- ·Ir·~nc"·~ 1""'ii,i1e=- .~. '0- f::' 11' .y' 'd-'ro' '~'iII-~'iII-~iC-"C' :Elnd-

I j.. ,'III , .. .lJ.l .. · . "".: 1 :...J .. " . .1, _ ~l~",~,J1,"·· ~ r~ ~ _I

'11y,dro'd:y'nanrtics :e-tnd th.e pb.ysi.iologic effects .of Lm_nlersiun, =r A(~,u.alic ph'Ys~ ileal lt1~.e~~lp'y ,offers 5 evie: I:d'l benefit·, o:,vler land='b~l'ed, pl(lysica~ ·_:h:ern.p'y for .peoll' ,e 'witb 'O,A, BU.oY:~ln,cy red:uces loadin.g: 3i'crOI$$ j obIts affect:rC1d, 'by pain, an.d 30110,.... s :b!e 'perfor.m;anc!e of fu:nct[o~na] c[os,ed.-<::hain cX!erc·'· SC" lh,a't o'tth;erwb~H~!' :filaJl' 'be too difficult 0111 ~:a.nd ~ 'W:art,e:f tlu:rbtden.,ce caJ.n 'be used, 3', a 'w'e'tJl0d, of itlcrcasmg, E'esis; a:nec, an.d .11' .rcellta"g'e of 'body 'wlelg,ht b()cn"e -across 'thl,e !o·wer.' H.m·bs can be' d. ·creased. or :~~:ro.g['l,. sSled .. in, l)'.roP!o.r-· Ci.on to th.e dep'th. of :in1nlersi.,o.D.,S,9 lh.'e: ·w:armtJl. :a.Il!d, p:resslm.re ,of tl . .'e:

water may further asstst 'with pain relief, swelling reduction, and ease of movement.

Despite the wide pread provisio n of aquatic physical therapy t:OI people with hip ,OF' knee OA~ there is little evidence attesting to it s efficacy :m 'this population, Althor gh .mlmy studlies have reported positive effects oJ hydrotherapy Interventions :iLIl1 cohorts with vm01JlS! arthritic oonditions, '10 j' 'W

have evaluated :a sample selected on the 'basis of knee OIl' I-',~p lOlA, aiio,ne ,. ','.

recent study found no' signfficant benefu of hydrotherapy' over a gym-based program or no m1tenrentloi'" for symp, ., 1 ,. J ~." 'II.~- O"A 'I I

toms m p,eoip e wit 1, nip or lU.llee ...•.•.. .: "

. "0' '·W· ... ' .• ever the ;p: ' . .'00-' 'g'PI'lI'Ii"ii"i 'Pie' ned b y... ·tll'; ae

~ .ll_ " L 'f '!Ii". " .c." I!i;,;. .• " .!~, ,i".llJI..Ii . .I. L'_. L,'\-.,·, '_.' . . ,I!i..,.

authors .• · made use of nonfunctional body posltions and, 1m,ad a limned capacity for progression features that may explain their nonsigniticant find:ings. M,e1dlodologm.!t:a1 lunitati.o.ns, :iln other published studies on'OA, include lnadequere sample size, nonrandom allocation, and no m," ention .. to-treat analyi' ,,'m 2-~, ';, Furthermore, n1'O c·t hydro-

therapy programs demonstrate Brtl,c:;' co n si d' e ratio n o'€ hvdro . stati ~'IC or hvd ro-

• .. . ·03_ :!L .~][u· •. '. '11, .lILI J ...-I!!it.c· '. ,:1. ~. ,J •. : '0'-'

dyn~unic principles in their choice of exercises" thus reducing the potential for benefit it-om the overall program TI' e- IJrescnl stlUd~! was design,ed. to! :ad.~ dr-ess the limm.'ta'tions olf previous shJd,-, iies tlrrou.gh. th,e u'~,e of an ·ad,iequa.tel.y .powered .. rand.on. '~;,'d ,oo'n'troUed, '[[1a1 'with mtle'n'Uo.n~to-mea.t anaJysis and a, fune- ~ ona! .p,nJgKSs.ive intcffenoon ·that m~lxiJl1iz'ed, the' llf - '''!que' .proper-tire"s of 'w:aler 'tOI 'op,thnize O'[W.tCOlr:Il.'CS, •.

'The ;~~im of th:is study "was ·to test tile ,eifie:cu:y' of :31 '~week a(~.uatic ph.ys:icaJ. 'n:h,e:ra,py p.ro'gr:am 'in, a ,g,[OU1) of IJe·,QI)ie with .·'Ylll.ptonla'~ic hip, 0-, ) knee 'DA'j' 'o.r 'bo'}1 .. T'h,(!' p:riim;31ry' .ly~pofhesi;s was fba .. r. .aqu,at ie p.bys].cca1. '£h.e'Lai,p'y woul~. resul in greab:r hI1.1~r,ove=

_;0 • d- 1! • 1-'~' it,'"

In,en'[S :In P':3,U], m.',. PJJ],'y~UCtlL 1,ILIn,CILlo.I1

'1I"l.. <'}.' - -W·' : '0- f "-ld' 'n' 0'-" "liq'- ~ o'!i ,( ..• C' 'p'~l"Y' €"~i 'C\~11 '('11' e'f-

I~Jj"ill!li~n,:,· ,'U 'C,' _~' ;( .... ' _ u,( .... _1.1:_ oj' JI" ' . ..,~.':_ ~_:' _. "" .

,apy. Th,e sle',con,d~u1' 'htypoth'f!sis 'was that :j:l,q~u:atic ,p,11y:sica] th"e.rapy WOil]~,id reo: 'lllr in. grea.t,cr lm.p:rovem.'en'ts [Ill,

stiffnese l quahty of : ."',:' " physical activill! ~ and rm scle strength. Finally J 'we aimed '[0 d, ,t.emlln.e 'w' tether participams were adherent to ongoing indepr ncl nt aquatic physical therapy once the program had ceased, and whether any benefits of the program remained ,6 '\,: eeks later,

Mlethlod IP'a rtldpants

Diagnosis was based on American College of Rheumatology classification criteria.' 6. j . Volunteers ago, ;00'10

years and. older and with hlp OA or knee lOA. were recruited b,y' advernsemenrs .~ n loca] clubs, lfbraries j' general practitioner's rooms print and radio .01.· (U)31 i' and the orthopedic

1-·, ., .~"" I "-'m 11:)

C nne a: 3j, metropouran nospitai, .J[ ar-

ticipants with. lint. ,e' OA were included :a they had knee pain, 0'11 most days of the previous month and osteophytes 1011 radiographs. Partici-

P ants 'W' ..,;·t·h ·~11· 'P" ,O'A'· . rere inc Iuded :if' ....

\ .. ~~_l~~ ."._'.lI,_ I'. ,w" ... _ .... : .... ":' ... , .11.1" .... .IWl.,"·_,lI"-Il· .iL,! .... ".,

they had hip pain and osteophvtes and joint space narrowing 0'.0, radiograph OIt'IJ..'er·· o· of'"'li- - sion criteria for

~ra' ,="" .' .··I!!.JLW.'_'_ U!!l;.,.-JJ"U;.-;~ .):., ~: ,.~~' ia Jl':_. ~

all participants were an average seve rj,'f}r of pain of greater than .3' em on. a 10=C.ll1, visual analog scale (VAS) and CUffi,iCII1ty' with stalr climbing, walking, ,or g:letti:Qg i .. n Ot 01JE ,of a, chair. Exc~.u,Si.'Oil criteria. iniclud,ed co,ntcdndica:tilo'.ns to ~,I,qtla.'-~ic phy:dc.aJ therapy 7; si,g,oifican.t o'itu:::k o:r other jo.tnt .:pail1:' ': c'nt (p're1oedil1g 6, 1l10n ths) joint i'lljectm,onJs l' slu',g:e·ry'll p:hysic311 th.erapY'l ,o.r .hydrortherap·· .';; E'ow!er .. Hm·b ~oint .rep:I:~hce:m.ent:; :in;31'b:U:-, ity to ·llJ.ode:rst.mnd. :En,glish.;, and. :in;a,b:i1..j;ty. to sa-~ely enter 3,nd exit tIl' po,at

Be·t~ree1l1, Octo:. e:Il" 2003 a:nd .Ap:rjjl 2004,3. 2 ·vo!un·le .. rs 'w'cre scree'med~ O!f th,e'se vo~.u.[l'£eers,~ 71 .fulfill .... -d . hie s:electi:on ,cr]terl~l! :,ll1d w'e:re e:nr,oU!ed ~n the stu:dy . T.l-Mrl11~s.:ix p',3rf,cip:,U1f S ·wer.e rando'.mi,y R~~ig;n.ed t'o an, ,aqu'tMtic .p[l'Y~~,m'cal tllcr:a:py ,groupl (in t,erv,entio'n, ,grol.p), aId , . ., 'p.'-ln],ci~'

p:3.nts w'ere :f.3l11Ido:m1y :assigned '£0 a, co.nt.ro~ gr,oup ~ On·e a.qu:a,li,c p,:b ys.ica] ,t:hera, PY' particl p~,rl't wi.thdJ1iew' ,l(~£er

J a.n u a.ry 2.00.:7

.33

A,q" U:~t';I'IC- ~Ih-"'Y":"!S";;;I'E""~III' 'T-l...la,lli"~'-p··'u fo ·r·' H!I"IP'I ~- d-'" K"',:'n-'llIi:iIiiiCiil 0"'" IA""·,

" 'UI. ,II F,,- ~,a I 11111~,111 Ui,.I' .. 1 1 ", a II'· I" llli:O'~',,··

rando ~~ lzanon, dld not undergo the ,in,'- erv fl' ~ion as a [: ca ted and, did n [

rerun -, l~ 't.;o' 'Ir~ r~' "jl'~ .. '·, ,.e.'·m-~I '1"iIi'it''ID'O' "(IIIif'! £"o;n-'-

~!. ~.IL-UJt I Jl! ." ~~, ..... itJI· ',_,_, ,,!t~~'!I; ~'~" ..... u '-., ~

rol . '~1 rt i,c:i pant ' , " :it:hdre",,' prior tOI reas se ~ .. ment ~ howeve r 2 of tll. OJ complete d reasse ·'5111' nt que tionnaires [only" ,All P{Ui[[cip"an[') provided writte ] info rme d, consent.

Protocol

The tr:'aJ compris ed a '&'\v'c\c'k inter .. vention perlod " - if~" ] .• 1" Particlpam '. 1" re re :a,"'"~., :,.' ' 1_ d :~ mmediarely before

trea ment (,i weeks) and hnmediately after tr atment wa .', compl tied (6 weeks), Furthermore. ,- be aquatic physical tb rapy .: ~ '(OU,p! l nderwent follow-up assessment 3,'[ 1..:.. 'week (ie 16 weeks ;,]ft ,I" 'the mtervemion was complet d) 't01 determin whe ther an ' ben _ 'fi,[< I, ',f th,1 Inn ',nlP'_ n-

It- lon 'w" -i""'iPP m alnrained in th ~ short

it '~" 111/0;, II!."'" '!!i-III_"I; W JI.'~'!i-'!Io,l/.lII,,~,~ -' I, '= ,~, 1\,..' b ,', "

term and to ~)S sess adh renee to :i.nd,ep,_'nd,f'D'[ aquati ~" 1)IIySj,'C~t~, therapy, E'V,~t1r effort 'W'I. made '0' obtain rea: sessm _ nt data on primary out- 00111e'·~. fr ,111 any .P',i_ flt'ru"C:i,:p,atl, who withdrew 'rom the study,

A.SiS,ilgl'.~ ment

,F o,Uo''\'I\fin.s, th,,·.· baseli ne assess ,0],1 .. n't"

P'"1iI'Ft· ;Ctl"~')""]'1I1'1j" " er 1 ..... '111). '~O"'mJ' 'v~' lgn 'd'

~R,1l, _.,III,[!::.. .. ~ 'li'_IIl~, 11,;' ... ' .-. _ ;._ Ij,~~ll,l., 1,1 ..... 1 .. ~,I A,'·"":·],I.I".-',IUI,I .

to, either rhe a,iquaU"c p1h,1,ilcai [=1 r.. ,p'. ,W10tp or the conrrol :~IiOU,p,. Bkiek randomization (randomly ,aJ'_'enla)tln,~ block; 01 ,~: and 6 stratified :for sex 'was, set up wi'£b, a computer-generared table . -,f random numbers, "Ms:ignm" ent was cone ealed in '.··eq,'Il],en,'thJ], OJ)3,'qUf! envelopes IJ1dl was revealed 'by arn independ ~1J]'£ (I'~' earch r no'[ :in"fOI~y - d

'in sment, outcome asse . ssment li 0:[' :in, terven I[io,", :fhU,olw,rnng

the bas 'Un" ' assessment.

Aquall,ic 'Physjjlc,al Thl,er'apy I nlt"e'lrventl~on

The aquatic physical therap ." program comprls .. d. functkmal weight'b ,arin.::~, :'hnd 'P:lf'O:llf! -': ':i:\re ,e e~rcl e'" . ,-·a,b., ~'.! jpl[O,v:id,ed 'mrice.~-ee,lld_)

( ~'I,='60 -,llinut"__.,:~, Ie-le'h) fOlf 6 w'c\eks.

. 1 'ex,p, rl'~I, ,c,~d a,'Q_u3,'-i,c :p:hy ,~IC'~t] theClI.}llst in"cU"LLuIU~r in' lrueted pa:r:-

IlneUg'ible lor dlecUlned t-o Ipatth:iipate; ('1'1 ;,24:1 )

...

o weeks, Consent, Ditlseli'nre assessment, an d random i'2at~o n Om ~ I'll ')

.1

,AquiI'tic phy,s~:ca!1 ;t'he'ra fly (n=36)

Dll"iOpou'ts (n = " ) , stress

...

....

IContJn.1,1 (n ;;;;3$)

D",o pouts" (n~:4I) :~~ ............... ~.:- , ,acu't:e disk

jp:roh\ilpse

, I aclk, o-f 'tiiml@ 2' 'f,2ilmlny ll lness

I

'J'

,1:,' w- .. r. D~JIl.;'ii' !D. ,. ~!~l.,.,~

Aiealse-ssnrnen't (n:,66,)'

."",

Con m~ pa.rI!iic'i!pa,nts o,ff,er,ed aqu atmc physi:ca,1 thera py proqram

no Of' ncdnlolaJ '-~yl1I1m't'Ojft~ xac .•. rbation. Attendance at itu['enrl!'.flt.ioo'f!ss,j.on.s, and, adverse ,e'Hi·. lC-: -=-, i - f~h _ fnterveatton were recorded ~-',- the :3l!QIIJ3,'DC p,hY"i(:a], therapist.

Upon completion ' gram, P!~ rt:lOIC'~ pane -; ,~: ere encouraged

to conti:nue indepe ndent ~l-=ua,'[i"c physteal therapy twice l··· 'c~ldy at a local pool and '.: ere provide d, with detail. of 'n'OC3_, pools and 3, ' . ritten de tcripd,on of the e 'r erclse '[I maximize adherence. During " 1.· 'oUo'w-UiJi period

betw een w·~ eek 6·, and "w": Ik· -, 'P"!I'ru'-"'c"~'

,:" '. ,,',' ',' '. " , "' .. ' ,', , .. ) , I·, . " " ,~,. I. eJl. ,='

._ '_' , ". '_ .. , ... L' ~ 11.. _. - .-

~,pants roaord,'od 'im,~ ~,og'b·· ··k ' h-' ,s-' ,jorn' , !of m,di ~_- ndenil ,~l,quaJtiiC' :phy~'j,ICaL~, '[ ]eflp~' d.l~lt th Y Wld ~:rllr·~· ··,k., 'P,art~c~,~, pa11ir~; oonrinued 'w~th 't]l,·ir lJj'-ua1 Rl,cd,-,

Fi:gulre' l .. ,

FI,ow of partklpants through the trlal .

'~i zlpanrs :i.n the : rydrotherapy 'po ·· ... 1 (W3;,' __ r temperature=Sd 0- ~,\ wit 11 a maximum of ,6 particlpan s 1)1 r ses~ :,i -' :111.'.,.:I1.,1,a lity 0.' ' ,[D,o'Ve,me At 'wa~~! . ··:m-

P ha ~; "'if. ..- -!'lll[)· - ,~,~~, jIi:!i, th ;i!:i,'po"ll in~ .'~ pifll ~Ii .... ~ 'I' -d'

'I! IlL_ - .l~ll.:... _ ~~ !£Il.,," 1 Ikll.lJ.lb lin ,I~ Jl.I~~r til ~ . !1;_1Il1~1,1: ~"I~·.' "

',' , ~ lo -_ .•. r-llm hi ,mu ~~Cli - ~lnrur':,· tOI '. R,-

""',llliiifi '!iI;Ii' • p.lm· :prn-"~I1j~' IP,nrn- 'itll""'lllot"'"it,;iO''F'Ii' 'It'~9Ii"i"'H1'liif'~hl~

. .. 1111,·. ;;;_~, . " .. .. if,U,;!I!... 'Ii;." Y " III.JIl !ilJl.,,", ILl It ;II !ll.-Jl, IWJ U "'119 ,II

'_! '_' '_' .

1011'£ lith .. ' iex.· rclse "'. Balance 9' i tb .ILn-

th ... ald ,of :1l1,U' , to' maxiruiz . r os 'und and Isometric : eg ' nance control ', .. 3,. ,~j -Jll - ved V: tth aU parncipanrs, . ~ ],l~'U-' tnd . pinal ,P'O' ~'~'Uon a1-0 'WI' UlU, aht: f~ _ dback ., ,t.'CO provided on, ~ostu r ',~ tfttl1Ui,V: =-1"S us, :[tbd,o':m1rlJinl<", muscle contrac'tin- "md tnml': co,ntroL 1ndivi,du~~ :p~ ,gf";;r_;·~":ii'n '[01 Slllb~e)qtu~~n't [),hare§; of the '-)ro,gln'l'm. '¥la' clinically d" te'm1r~I!1""d 'b} 'r:h:~ th,~ 'l~lpi 1 fmd occUJrJred U -',on !CIO~ :~lletion of ebe- plrior :ph~il . ""itJ) eU:l er

'T~ Ilb~e, 1 ..

Aq ua ,- i c P hy:s ilea I The ra PY Pirog ra mit]

-P'h

_' 11_ilS_'

I

Sab laid _

H, '1, : .• lli .- 0111 (Eac: [Legl)

I

!·"mID

Xwp ·'i~t. 'lin- rum (.~B% ~ .' ,~;% 'vtfB)M

2

L

·-.If~ _',. II.~

I\·J.

L.oubt=--I L!? , ~I,ua- -

z, [)ou'bile-~l,t!,l'. ,e-lf' ralses

- ! I 'or l)hfL~. I,~ ~),lu- ,':

.'~n:(de·~c,' $[ _D,I('E'.I contralat ~'1'31 k_ ,"'" lilt." x i:o lIcx'[len, jon

-..··il ~,lIl~e-I-: ': ' tan- e.. n "raJ~:[!-'.a'I hilpl t I . lue i .11ll/;ldd.'u_..,r O:IJ

.~. :··'i~ll,gltt~ .. leg . quat·

...:. Sin-~·:Icl.l g, -. ,:tU re.'· es

7

~.I '1

I

. "', t:'

A,'~'_:;I

"-"s fur p:hrlSC 6. b t for . " ',crc~s _ ~ , and '; "In, '1:,. I I: e "p' Ed (I:" ",·:st:Jlln ' ) )f

,M: )vwng Ilt,~, i.~S i!lllte

A·", ftor :rJ! - UI .. -.1,' ,

-~' " ~- ,Ii' - _111J:JIj··~ 7

J-\",' i~br phase 1.

'[0 rn ill

,~'X [0

2XUJ 2XIO zx io

1 () l'J'ru:ilJ

'1 () fnlii 11,

2,X1.0

.~x 111

,~UO ",' b, ~ X"':

On1tln

-I

}XUJ

:~ 0 nun

u ta,ch session incorporated a w,aJrm·,up and a cool-down (2 ~"fj;dU,s 0'( ·he. pool wa~lking fCHViJ2U'd" baclk,w,ara; and s:&d€Ways and hlglhl -5"Plpi~rg)1 (onduc~ed '. t th~ depths il~,di:Cdlll~Ed., Walkinlg ;Iimlm,ed~att.e'~y -foUiQw'ed I~:he ,(,omp,le:~~,on of lowler~nmb e'xercise:s Ailil :s~ngle·h!gl,eX1erci:se5 'we'~~ perf,ornled with both ~he le,ft and th: righ~ legs. The :St_p 1"-~911t was '14;5 mm. AS~S,-an e~ior S,UIP :rior mac sph,@. WB=weigh'~ be .-·'ngl•

C :·.Introl GIF'O .. Pi Th-' con rol :~·roU,PI d'id Dot r: '. 3'0" aquatic physical ['h. 'rd ,.'1': ov r rh 1 6-w .. ek trial: howe ver these parncipants 'W' 'll ~ If': red f1r tr terven-

rlon (OUOI:" ins. J I ':'- V -"":- k ,a'. ses :.~

am

Iri'· 1- ry' Olu1tcomle'_

Pain on m .V' ··m. '.-, t ( ver th. preeed-

'.11 and 110(- t'O·::~I· '( k •. ' the prima .~ joint

. -ar~, measured ' in i-C]ll

.'I·IA·

" " ~ . "

-IIf"iII' , IIl.JJ. .': 1

. .... hi : '~. 3' ,u' iaware of group assignment performed all out-

ii',ii--. '11i"lli1 !II..Jl1. -IL:II

I .3S

A,iql~i-atiiic Physlcal 'ThJl@lr,ap:y 'fIQIr- Hlp and K '~II'~e OA

. - -

SeICIOll11dary:- OU'; comes

.-'

Q,uestionna'irie'5'E "~ ~. -item .. ~~Jll9iji<ll,t'il.a

speclfic

Muscle strenqth, duction and "I\1;}I .. Ie

~'. trate - ade qu" r t ~t- - •. '( '.[ r-cUab:Ut . Sa mp Ie' Size

for the llU··c·~",~., 'r:o of fL I lower limbs in j\, J~aill. reduetl :1 of 1. "':", ICOl on, a,

_ n' :;~·ti,'. nouah IU.')i- Iscrin 1- at b tv~.rl· en rhos 'ii. ",'(hI kn . 'e' 011\ a- d '[hi. :. wlth- j. :i'pan'[~' 'to ~dlo1~'

U" •..• - ~ Partici ant'·'""'[ .

ban .. ,~o' '!. on the ostc -r arthrtnc limb in

front I :~. :3'rpl and were

U~ 1 ","1 'n 'I .. "'t" I '. -d - - 0.: o· [lO·· ' e'. [' '. I. ,1'.""Ii p, 1i,t fo "1'

,~I-"II·· . ," _ _. . _I~_"_' '. _ _' ._ " ·ltJ.', Jl" I.!. . 1

on a - d I. ff itt " ott P as [ 1~U1,,'

PI.,. 'i '11· !I,,r,,,r 1 .... , I.' .. ",'. mds, -hi" t! st

do. I .. , not require the participant t( I 81011' "" b dil' ' .. ' eigl [ '\ L '! ' hie' st.:. P but .:iD]~::~Y 1,.1 perform ott :p'" entlally de stabi ~ i z ~ ng f 0'[ ph'. .': m .. nt ac it· it_, .

he numb .. er i. ,I 'nim! "~I t -,,- I" rticip',~nt could pl ace I[ 1'·, foot on If. he step and .r. turn l [0) the floor '\ as rec r ed with :~i'~h,. r scores 'wJldica'jn,: bert r

~)'7' ~"I iiI"lI iT"fi, ,..'" .

:1 . 1~1i ~,.(lt ILllf~ . _ •

[:., !D" munity-dwelling 'fi:,lllP

101. er .1.1 opl - (in rae lass c rr 1 arti,IOf], "'-'0. ", ffici ""I-"'·'·~ [1. ':1 ,',11 = '. "",_'~ 0'0,1) 28

~ - __ ' _ ~ l._ 11111 e- . • . ~. I ~ !I

Ballanc" .

1-:' I: I _

.. 1 ,.1 1-, I!'

. ':-:11 i I I'I~ C(lmn~'ni[ .1.- d ;,: " h;·. '_~lini"1unl cllnically tmoorea .. ,t ' '", - ~, r:. 'le:' ~ o n d '. t. tee -, in 01, ',~ tri Is, :\'~ W if l'

nar-

~JI,'~,

~

, , 1 . "'tS "i--

. rl' [-'-~-'- -

adduction mo_LJ1):_·nt.~ ... I' ,-'1]1.· quadrio ',p: femo -:~:-, 01'_'~ , nac ',.

~""-,,~',

II1.J I;.,

[Data A 'al,Y',s:es

':L l.t~ I, anah .. [ I'=- performer with

"'i ~" il:-.'i ar : and an alpha [:",--1 '" f

i ,': I." 1, '~-'n intention .. to-tre at bas "" T~l·.

"m1,1.d

w _

. ;

':m~lL di um,

• I

"ii Ii _

U . "1.IJaJl_·: '

',ddl·· rn:Uo,~

function J :a,b:nmty"r 1 This test demonstrat ed ,: rood intrat ~ S~[~ r ~ md tnt 1~~

1: bU" '... -~' ·

, " "' r' . . I'" -_

r " b~', .~,t) .,.. ',~ '-.", _ a _ fl-

- tric populati In titS ~ ~ E~ a r criterio

.•.. n:loom .. ~· at ." 3J1::~ inl~ rventio ~~ 1.11- 'OUP' ~! U': of p~ ,.: red t

compar '.

~." ~I ,.1I1LJIh: ~

to" - I. ~ nit-

o. " I i. -_ .

'-1 p .... "irD'I"

1_ _ .",. JJ= L,

. ~,ix,-,M in U'

Th,

'~ -3.'., UlS' l(j. '0' ~. a uate h ( ~ far parti '. ,_ lpants I. ou~,d walk at a r~F\- comfort: b,~(, P",,· . ~ Th'i., (I '--[' I'~l'" V ~ c .i:da,[· .

~- 'T··'·~ I.~- ,', of rhvslcal 'f-' , "'t"''-j-:- ,"'

a meas nre 0.. p 1,l II, I,h U ~,c non lJl,

Pi o J~' :'. 1'tll hi c_ art - a i lu e an d n '.' 'piM'

d:i'·· !r~U'jiCI~1 r ... corded 'in meters).

Ian

2007

A ... ·· . tii .. ) IPth',"," ;1; •. ,. I T' th" " ,,' -. -, ~ fc -.- H·' .' nd IK" '.',' 0< A'·", . ,quia I,IC - YSlca ,e.lrapy or ,,-_llpl aln_·"nee I.. .

Table ,2~

IB,aseiine C·omplar.abnl~y of' Partkipant Groups"

Pa'r·-meter C'o:ntro' GI,OUp (n=J.,51')i Aquillic hlrs~c,all
'T b,l!lF DiP' GlroDlP (0.=3.1)
I }\g,t! v 61''': (7.8) 633 (9.'~-)
'J .j
.. . 1 ....
..
.H ·~.8bl, n1 I 1.,61 0.01) Wll,' (0,1 9)
• L
I i
W''''wght bq!;, 85 (1' :AA (15)
Body :fll:a. index tglnru ,32.9 (6 .. 6) I 138 (6,.;)
," .1 .•. "
·'·ynp 0:1]] IJh ration, }T ~ .. o m n.6.) 8.JJi (91.~'
'e (%) (6.) fetllail l: (l) mal.· : 6- fern I l2 (3.3) male
no. I .
, .... - ' . .
':··}-i':m.pl.om3!Uc jO(in~j 0.0. (%1) I , (69) knee 1.1. (31·.·. hi.p 3] (86) knee, '5, (l ) hip
.... ~
-
" :ccr c~n~.on 00", (%) m6 (-:6) an ailge :iC" . 70 (:;,6) " : l]g.:,,· 1.-
'~ . ~ .. --:..... -.' . ~ 11 ... ' an~ .. eSU;Sl
1 ( :) NSAID-~ 18 (5Ifl:, '. AWD
~ I ..... [ 'J:' .~
. , ., .. " "f
1. 'j nutraceuticals" 1. C'91'1 nutraceutlcals
.. ..
Pri'mary onto ome
A , movement pain, 0 lO em, t) (2) 6 (2)
s· ", .. 'lfid1'l1' mtcomc .
, . ~_.!!I.:,---'-~ I
.. 101\11\.· pill - 1'99 r'~,) 2,1 .2 (79'
I 1_ m.11] .'
...
I woi - ifftli O"'c.'OO 11 0 i(6) 9(1 ( 6~
r., ' '. .1.: I~ ·~r:- mm Ii ~:. •
WO.MAle .fUflC~:i.IOJl , O-~'!' 00 msn 630 1(3 I '5) 5' (32 )
AQol! ~I .1.[ :4, '[0 lJJO 0;.';,2 (0..20) 0.38 (0.1 ,~~
p-, 0 I 15 (-9 165 (801.'.
=I," =- ..
. ... ~
(-'Up abductor Sl[engtl. . kg I
,
1
Righ~ '1.0 ( ,,2) 20 ... " (8.,.2)
left , ,;,3, (8 ) I 20.,6 (8. )
,_ • L. ',~, ":'
Quadri ell. , f,C;;Pl01.i ~ l. mscte IW ngth. t.g I
Ri.gjht - (H.~ 26.6 (9.l)
:__ = •. "1
l[ewr '- 3 (8.3) 2,3.2 (St3) I
....... '.IJ~·
.~m[ d 1;;1 .. &. G ii1 Tet.~ io, (2,,8 ') 'W m 7(1 Ct,
P '0. ,
. , .. ..:.. )
" .. ilx-MJuuC,e 'W,Wk , - est . 8.0(' (82.88, o '-6 (9 .. 101
Il~ I ,." - ! I
_ 1]'.
I 'tpi test, no" 0 steps l: (_.) 13 (4)
I (I Data a r,e p rese'inlt,ea a 5. mean (SID) unll'les.s otherwise i nd kated, AQoL =Assessment olf IQua Uty of Ufe (with hf 9 hie r scores i Ii1I dh:aJti n 9 bet~e r q uallUy a~ nile)",

N SA~ D'5 = nonsteroidal ~n'i~ij;nfllamlm!ato,ry drug S'j1 P.A.SE = Physica I Activiity Sea le for the ~I!derly (with high@r SCOlrl!S indicating 9 ~e ~elr phy.sic8 ~ activity t VAS=Viiist~,all alr'H~llo, sea lie' (with h~g[her scores indi[c,alting more pain) .. WQ'MIAC=We's'tt.ern Onltar~o and McMilis~e UnirY'ersiti;es !Osteoarmri'ttjs lindex (wnh higher scores indic ti,n,g wo~se paiinl, ,s:~ii'ffness.", 011" physk.i!Ill function),

b Nu,.troc:eutica~' cam be d efli'ned as a ~ood (or pa rt o'f a . '0 ad) that provides rned ica I 0 ~ he.al th benefits, i ru:ludi ngl the prevention or treatment of ,il d'iiseas,@;

itypicalilly gil ucosarn in@ in th is population. - ,

c· :Srgni~icalni[ly diffferen~ from '¥'aiue for control group (P < .. 01 )+

ti .' ',' or 0 I' rcome mea ures 'ab, 2',

with the ":. ·x· ... .epnon of (J.·ualiry of life, which. wa""j.gnifie:an.tly pooF,er in the aquau :,_' physical 1 .. '.:, :'""alll~:' partl :~.~ pants (P < ... 01) ..

I]···1Jl Otl.D10V'·, ment of3·% from ba seUn.. and thus . " ... 'm.onst.r~l( .... ..·~\gnlfi-

cantly less, 1):31in at 6 weeks ._ han con-

tr II Pi' 11"'1";: ci na nt IC' P ... , < 0' 1-) C" "':11" ,,')

.· .. 1. :., . ..I!.lU ~Jlll.L. '" [Il ••••• .'. ,', ,t';~ .. ~ _I.ij

Thi finding n p e ~". nted a mall :ffi '., , •. iz ~ 2 fo tID', outcor 1. c • I., venty-two 'pre. nt (26 of 316) of 'lire Interve ntio 1 participants repor ed a global improven ent in

pain; I' nil' 1 .% (6 0.' -, _ .~.'. of" 1_.. cc ntro] participants did so; (P <.,001) (Fig. 2). Similarly, '. '51% (27 of 3,6) of thl .. ' inte:N[" 'n' i .in participan [, Jr[C'" oorted a, .g' bal Imor vemen in physical function: I .. nl.:~ 1 .%, •.... of ~Il) of the contr .:-, nartf iipan ts did . "0 (P <.001) ! •. '1~'_',. ,2." '. ·!qu3ti.c physical therapy ,- iarticip

P:r-imalry Outcomes

Aq .. uatic :p' rysical the " ~a,.py particlnant ! .r, peru d 3, I' ean .r~·. ductlon in

JanuaJlry 2007

37

Table 31~

Outcome Scores at 16 We,€ ks Across Grou ps"

~
Outcome' .X 1(:5 D) [PI EHKt
Con'tr.o.1 Croup ,Aquati" P;h"s:htid 5 z,e
1(!n=.JS:) - @rapy GI~O'QP
J (11-),6)
Pri:m;lry I
VAL.:, :nnmrclllU;:l1ll[ ·s :1-:11 ,_ (2) (21 J1U3 ,,2~ .'
PIGtUll I I em, ,
·ec ndan
,.
\VIO·:lA.C [l3t-'Jl o~ 00 moo, 198 (lOS.1 om 1-3 (7'9) I <.OO.~. 02.-,
. ,,:u .•
,
''''iO ~1A' _. '.ff U~. '-:10 9'1 ( .) '3 ~ .. 7
un ness. mm ." . .-
J
'\~/OIJ\,1A ~ f . o-r, 00 6'56 (~I 3)1 ~'98 (3 ~.61) <.00' . (]IS
.u ncnon, mm
.~
I \Q~ l ~o..O to W_I ,'1,0 ( I ) I , ,3 I .. 2: I '11 . ~ 7
, , I
, '" -- .
lP, "lE 0.- ,00 m. (~7) I 16~ ( .'·n -;. - ~ rs
I ".~ .... 1 .,,' ... ':)
I H'i·,. abdu [or st len tb. kg
,Righ~ I 2:0.3 (oJ)) 2_~ (8 .. 3) .0 :2 .is
L~ft 2'1.0 (8.(1) ~2.2 (,g. -:) .. 0'1 '1 .07
Quadriceps ren10r~ -:- rnuscle trength, kg I
lUglu , .7 (9; .-' I ~9.9 1 15' -9 '3·
ii, _ iIiiiiiiII!o " , u "J.- ...
Lel1: I 2 ".91 (10.3) I 25,.7 (m.O.6) 'p ~9: .0.
I~m; .. d I Test, I JI '3 : -,H, IO~ :)1 (1.. ~, .00
, , [ 0")1'"
. .. . ~ ... ~ .
I
I I
.j s-Minute \,\la~k Test, .38 !(79.0- ) I ~, (87 2'~) .001 JH
m ' ., .. ,I.~ .. ""f~
r steps I ~ ( ~.) - 3 ( .998 .1
.. t :p rest, n [ , I)
, ..
~ a AQol~As\5ie'ssment of Q~aJnty a·f' Life (w~th hlg~.er scores jndlic~[ing better quaUry of ~i:e)~ P'ASE = Phy.sk:·,al AC'~hdzy SCSIlle Ior the' 'EJch~r~y (wilth higher scores indh:ating greater physical ac"Uvity), VAS=v'su,all alnalog scale (with h~gher scores ilndiicafng more pain).; WOMA.C=Wles~er1n O,nta~io and MicMaJsiJer Unliversities Osteoarthritis Index (with hlqhe scores irn;clmcating worse peln, s.Ufifne'ss,. or physical function).

On.t ""iD

Aq uatic IPhy-s,icall Thera py D 'Control

I 2 times as likely us control participant . 0 r port global improv 0.1. nrs in pain ( .. • ... R = I 2.6 '9 ~'% '._J ==~ ... 01 _ ;:19.-4)_ co,rl .. ' spending [I. I ,a_ number n '··1 d ' . ' treat of .2 (9)'-,% C] == I·_ ~ . an d .:1) i11 , :~:ii·ca·~ func rion . OR:=' 1. 2~.", 91'5% .: 1="·:, .. 9- O, ..... ). corresponding

ded to tre at ,0.: ~

~, 1000/0 IE:

w

E

~

:> o

lI... 75 ..

e,

E

.500/0

2'5'%

Secondary Outcomes

Th . aqr atic physical '[I .. _ Fa' ~y pa rticipa .1J~ .["1 eported dig, lficar tl. ,1 L -:', 1);;;1.0 - md . :tJlifican'[l~ '~. uperior physical functior '. manv secondar ,01 t-

~

c om ". '.:. (. T'" b . ':: )': Hip mu I'':''JC·· "1- e '''''~'iII''P I'll et '1']'

'_ .', . . a . . ... , .Ii '_ !I.li"W, __ ..' ~'I~J ~tI~

an , quaJit), 'f U£. - a·o '\\II~l"( . C31Tl~- ,gf1. at er in thi ~.t~ roup than ui the control group a:-' 6 '.' :. '. ks, Out-

·.I.m.':' th tv, .. r,· ' n.t 'i.,nifi.can't1r '.' lif-

'&1=0 'P,J!Co 1I]'i' II-~O m t ow m n g th ·iI nterv '1\1'U" on

.Il.I~Jl, IL-.lI . .' L. .~ .... w ll. ,I '_. _" ~' ~.:_ _ _ll. - ~Jl ~c - ,,_. 'JL j.' : • 1

IP'ain

~-:'iglure ,2"

'Globa,lll improvement hl plain and phy:s~'(,al 'function at 6 w'eel~s across glroulp'.s ...

38 - Physical Therapy Volurru S'7 Number 1

January .2007

Tab,~!!e 4,~

Q utcome Scores at FOil ~iow=u p ('.2 'We,e ks) in the Aq uatic IF' hys ka I The f,aJ'pry G;tr-o u p (m11J =, 3,,6)'~

p

4, (2)

,MI!., .u ..

,!

4, (2.)

Second~.ry

''N,,\\,;r'o)~i,~ l',C: " "f.~'"'' ",),_,=::,{1j;;') .",'

l'V . I:rU1.· [piiillLn. 'l, ~ U!I. filli.W,

.05

73 (45)

A.Qol, - o. 04 to .I.. no

, .. 3:ru.

'0 "·3'·' ,(101 ?,ii''11I)'

" •. ':- " .. U .. Ioii.iIU .. "

0", .; (.0.22)

reo (1;10)

'1'3: ..,. '("'1 n '7)'

l_:.·ll1, ' "UII!! "

A"

.ri!:J~ . ,

?'7 7' (CI:l:)'

l~;~. "OIIJI_

Q., ' .. d ~. . " ~. , " ~ '.. . , ~I. st " ,[.~J.,., In~· , " ,Uliili. ncep\S, remons .IlJllusc:~e s n.:~'iIl1,g'W'WI ,D'ii.8

'1'7 2: ('8" ,~,)

~I~ •• I . "I,"

?'1 8' .f\Q '0)

,~ [I • \U,.o:,.

.46

.47

2.,- 7' ('l,il'lil ,6' ,)

~. ",u •.. ,'

"T'" ,...;I '!J:U'" .v.. G .II! '. , ~.

,~ Ul:l~u up iI;X I 1'0 .est 50

10.32 (1.94)

9.9.B (1.93)

il" j v :!i.A:' ... '·ll· .. ·'''" ·,\·!!I.'l·<!'l~lk· "1IrJibOiIol'[" Ill'

.J!'.bii1o''',( "lllJJII ,,'I!;,,- 'W" W .'. JIt '!!;,..,;:!'. ~, "

,;·1'- 2 (,8;- ., '~)

.. , .. '. -- .'

13 (3)

l4· (4)

,a Data. are presented as, mean (SID) ulnll'~ss otherwise indiceted, AQoL=Assessment of Qua~ity c~ LiTe (wi'~1h higher SCQJies liindicathlQI better q.lUaJUrty of Ilife)~, r>-,A5E=,P;~y~.r.call Ac~iVti'ty S(all,~ tor tth~ Eld~u~y (witn hii'ghe[" scores ind~"caltiiF:Qg glreater- physiic&lIl a(tii~itY)i VAS,-vi5U~~ ~~;,~dog scale (with h~ghe'r scores ind~(adng' mere pa'ln), WOMA.C ='We~.te.rn Ontarlo and MlcM;a:s:t@r Un iwnTties O'$teoar~h rj'~l~ I ndie'x, (wj'~h higher scores indk<Jltilnl 9 wor-se pai U"D", st~ffneSSi lor p ni)lsicalll fl.JlnC'~k)n) .

,b Data, are presented ,~JS, media n (lnterq lUi~rti lie ra Iillg,e) and 'WE'lJIe ana Iy.z~d wiUn the Wilco.xo:rn :$tl"Q n ed rank test.

stre ngth, ._ -.'. s ep test, the Timed u, ",P' '& Go" Test, and the PA';·,E,. Effect S],Zie'S fo ~ I .... condary outcomes w ,eriesmall at best.

,A:tt'e'n,d,anllce and A,d1verse IE,fflects Only 2 IL)a:FtJ.cilJ311 ts fail :d '[0 attend all 12 aquatic physical the" apy ses,·.,l0115 (exc luding the participarn who withdrew before' attending any sesI[OIllS); 1 of the', '. 2 part iclpants attended "0 ' esslons (8,3 %)~, and tile

ot I]' ~ r 'iI!'l;!'] rtici P"'" nt ;i']I tte n{'II;IEIJ'd' ]'1 "il ,~~,(:!'

Iy . ,~,. ~·~LJl, L~ll." .w" . 1'~1I. ,L a L~, . JJ,~I .... 1 , .1. ~J~ 1;3'-

sions (92%) .. Adverse effecrs were minor a ad d'~.,d not affect ongoing partjcipation. Seventeen (4991l) par .. tieipant: reported mild joint discomfort, 3 (9%,) . 'eported .DIUd lumbar pain, and 2 (6%i) reported cramps in the calf or toot .'., po 1 cornp etion of the program 11 participann (31'%) had reached phase 12, and 1. (3,%)! '

(3-' rD:.l') '1 (:.lOL)· "} (. "'O.l) 1 O' (. 2"90./)' d 9' ,'iOll .lj~L I .~IO .' ... :'·/0: ano s

("2"",,6,' O.lt)·· t"" d ,,',' "1'", d' ,', ··h',·" .' . 6"" 7 8'" ':9'1

I, 'TtL j[1,{~,' .reate Ie· p.. ,a.ses,~ ',' II ' ! 'j

~,

I, 10 ·fmi n d ~ I' 'ii'";IflI, ""p" ecti v ely

, '~ !till, ,I" lL ,.1. 'I!b.:li ,I!II.;... '. ll.l .... 'L,il, , •

Ongoing Partlclpatlon and Outcome at IFol low-u Pi 'in the A,qua.t~,c, IP'hy',sic:all Thler'iI',PY' G oup At follow-up, 8}];~i ofparttcipanrs (28 of 33) had continued to undertake a,lq uaric physical therapy independently since ecru i~g 'the supervised. p:rogr~lo'l" Over the' 6=we1(~:k follow-up period, 24% (8 of 33) attended the local pool tess than once per week on average, 4 581], (1;, of ,;; attended

1 or 2 times ,per week, and ~~ 5,% (5, of ,3,3) attended ~ Of' ,3, times per we k: only ]6% (5 of 3,) fail -em "0 attend 3.[ all, Follow-up scores at 1.2 weeks for the aquatic phy Ical therapy g1ll0Up were generally unch anged from scores obtained at 6 'W' eks (Tab, 4)., suggesting that the benefits of t 1.·

program were maintained in, 'the S 11-0 rt· term,

Dlscusslon

Tlt1J, randomized controlled trial eval u~t' :ed th ef ~ cacy of aquatic physical therapy for hlp OiA and knee O'A,~ Our findings demo n s trat ed that a ~w'eek'j' twice-weekly program leads 'to' reduced paln :3JJ1d, joint stiffness as 'W' U as Ul111Ji[O,ved pb ;)'si~ cal :fiUI1Cl~'011, hip muscle strength and (JIUa1Uy of life :m peop e with O,A," Furthermore, the benefits of aquatic physical therapy appear [0' remain 6, weeks aft ,r the ces \a.tion of the supervised J)ro,g,fa:mn~ 0 .splte statistically s~gl1ifi.can t .' ifferences betwe n ,g:rollps.l effect size calculanons revealed only small benef ts of aquatic physics] therapy , or pain, stlffness, right hip abductor strength, and quality of life and doubtful clin-

39

A t'" Ph Ii, I - -h f HI;&; d K 0"A

.",. :.. ",[ '. '. " .. I , . - '", -:. - - ,'_ - _', -, . -J : = - - -. . _ ".- "', . I .",' '"

, ,qua, 111[( (' ,y:~ncal I 1_ erapy I_ or - Illp [an~ \Ine.e/ ,

'leal benefits for physical function and left hip abductor strength,

flew randomized controlled trial ' have eval uated hydrotherapy :m"t,er.v!e,Ill'rion~. in a sample _ elected O!D the 'basis 10 -" nip or knee [0'·. alone, I, l~ .l~ z, 14-JI"i Our find-

ings of reduced IJa1n, and improved function ',' ',', ,i:- h aquatic p.h)lSi"crd therapy ICO'O rur with, the :fitndings of others, :! ~I:t 15 :, :'~:o'wever ~ 'l11C 'most' rigorously designed randomized controlled 'tri',]] published £0 date found no sig - :~' - cant change in WIOl\(AIC scores (pain, : .. ,,'itift'~, '11~C1C or fi~ merion ). -W"~'IIf~l" hvdro .-- -··th:-- erapy

, ,'IJi.,;n:1.J\j1 . I,. . . - ,.... IU '.. . .. '. ", " "_' !..1il,tlI. " i '. :__._ _ '-.' _ =I~~ iPJ" '. IJ

T'lO' mpared 'W-' ith 1- "'l P1Tm' -l based streneth !!i.;..-l I " " I I ,if-!J.= 'III;".~,:. ~. ~"i;,j , ,~, ' "U.;j~ i ui<1JI.,l:IIbIl.J.,6,lbUI,-

~n 11]'~;:r '~"""rog'P'1 ft'] 0" 'if'l' no tn .... ervenaon ,ii'illl

",",I,.lU,O' l!Ji', .' ,',IL ~UL1.,'.II, ,', ',l-: . ,W, ''r '\,;.,1J,I!,I!I,.!t' . "., ,1IlJj,JII

10'5 particlpant "wi' 11 clinical hip Of' knee '0'-'., I, ~: evertheless, hydrother-

apy did result in improved walki:og di ranee and, :~,e:ft (~ua,drice,ps femoris muscle strength compared wnh no intervention.

In contrast to the program of ': ~oley e [ al I, 'I [our aquatic physn ":all therapy program primarily focused 0-.0, •. exerc ises :~ n func tion 3.1 posi ions 'j was progressed by increa ". lng resistance (weight bearing or '[1' rbulence), and, incorporated a walking component, features tha'r, m:a y e'xp lain O'UJr find,,,, ings of ''''i,g;nifi,c~tn t i:m 1)1r'O'V,enl:en'_ . lin :pa.h, a'nd m,o'· ':[ . ·eu.~repolr[ed a.ll1,d observed, pltysic-a] flLlflC,f'01Il, m,ea-' Sou,res. Difle'I'if,nc' oS '~n ,:tud, pa,ttici-, pa:nls a so ,][13,)' accoun:[ fO'f ' ]l[e COin,' ic'tiing filll,d,jJt.gl '[,. Pa,nici.llru1t5 ill o'U,r ·nl~-Y':""",e1ie- YOlulger" wlere ,more' -fl-eq uen tlly Je',nl'a,h~,; 3..nd .p.red.'o.mi.:nanf y :had ,kn"ee OA.. lm,po':rtwlt:~,Y', O,tur' vo'_,U'Q'[IC1erS werle rec:n~jt.,e'd :pri-, :ma'rUy fro,:m, the cO.mmllnit, :ilathe.f.' th.a,n .fr,oll1 a.n o[:rthiop[ed:ic ."',Ut '[e':ry' wtlitin,g: :H$'~ (-4[9{) of p[a,rtiCl[Joallt, in th!e stud,y of Foley ,et a 11 'I), sllggest-, :i,ng [_h"~ a,cIu:ati.c p[h}tsic'a~ flera"p;y' :m.ay be ,01!0[:.·' e.f£ecti.v-e for _l[ess -,e .e.f\e- 'DA, :ra,th,er [htl,n, ,en,d,=5ta"g,c:' dis. '3.se.

Quadricep femoris mu scle strength ~~~, "0' ci ated """"'W" it ~1 knee 't'ltli'~n sev erirv

,1I.!U! !ifJl "." }.," ,"' !f!Il)L~1 ", \: .:. ,til. ·~I. ,~,~ ,iJ!~I.',. ..~ M,~~ rI ~" ':..", .. " I~ . I~,j'

tn knee O!A,~ ,25 .2;' although whether

muscle weakness C'31'USe'S knee pain [or vice '\H~iS~1 i unclear :3'--. present, ,R'f!IC - nt work demonstrated an as ociation between hlp abductor strength and, the knee' 3ldd.uct~,on, mom nt, It has be-n postulat .. d that stronger hip ab ,1L crors help to stabilize the contralateral pelvis during, 'walking and 'by vlrt 1_,(: of the effect 0,1,1 th, body's center of mass, [can reduce [he adduc'[ion moment (0'( compressive force) at the' knee.>' 1-11.15" :i'£ is p~os ible that improvements in, hip and knee muscle strength were pa tially responsible for the improvements in knee IJaIn, observed in the pre ent studv.

, ~

Alrhough changes 'WI -r not staristica,U'. tgnfficant, ;a.q u a tic physical therapy did demcnstran ~ a .. mall effec [ size (. ""':;) for right q uadrtceps femoris muscle strength and a . ,mall bur statistically signjficant effect for the i.ru,gh,[ :hJ P abductor _ .. on vel: !el-y' it 'is ;3.150' possible that reductions in knee pain were re !JOI,n, ,j_b,~,[e for the

small strength gains evident in the present study with aquatic physical therapy, It 'is d-if1icu' t 'to iden 'KY the m,ech'anjsm 'Und,[e'r~yi'n,g: [he o:b·-e:nredimp:f,ove:me:nts :i-o. stren,gdl, 'b;ut 'inl= ,prov[ed ff:\cruitment of :fl1(Jtllr 'units .D]usc:~,e :hype:rtroph'Y'll pain ~tUev'ia~ ti,on." O:f' :r.[edu,,,~'ed :kue,e j'oinl c.·:weU"ing arre' mH, pios'ibi~ili.ies.

,A, ,p;laeebo[ effec-, of ;~_~qU;Hlti,c physicaJ, '[hera,PY' cann,o' 'b., rulc, ':, out 'b'call ,' .. [of "'h:e' .bl(:k: [of a, plac[ebo, [conlro], in. th.e p'rese:nt S,tUli-y. 'Placebo[ [cfle'cts :3U!,'ie COll11l],On in ,kne.. OA,; :rre',port .. d. unpIov ,m,I-'nt' 'w~,[h sham, in,t.enlle:n-

" ,&_ 16'J1'; 0011 -~~',I'I -_::::.=,'

[:1[011 f;Hlng,." ~,to'm ltl>',,-O 'to ,1-0,. JL .~

flo;weve'f. a nl"e[a,-ra.n.a.~y is. o.f l~l~,aoe bo[controjied c1Jnjc~d 't rials 38 de'm,!on~, stralc(n that p'~aC'ie'bo's :ha.!. '[h,le- gr, a.t[est~' feet o'n, con:d.lluoU§iu'bjeclt]ve 'OlJtco'Olie's a.nd :rn.n, '-:be t[,t':;1.t11l.1IJ,en't 'of p"a.i.rntl, with .no signific!illn-'~ ,efie'ct o'n [obj ecti Vie :Il11e~IS llrres., 'Giv,en tha.-[ our study- d,l'l :on,' tra td ·en,efi.'cia~~, ef=

fects of aq uatic p:hysica~ therapy on observed obiecnve measur s (hip muscle strength and 6'_-' minute "":'~-11'~-"'"')'

" ,!U,i;J;" ,1,1 ~ L", 11..W, , lllitlll ,!!!-': I '.l'" lli_,= U,I~,,,,," waJJ'.\.I,~

~t :~s u nlikely that our findings are a'- tributable to a, place bo :("\e .. ' ',p,onse MOD,C and likely that 'l rey may b e attributed. at least partially, to 'Ute interven [hJ11 itself

JO:io't. stiffness was reduced with aquatic phy d.ca~ tk erapy and thh re · ul t D1.a~·' be at least partially atrnb ... utable ro the 'warm -wa ter enviro ~ men t of the hydrothera PY pool, 'WarmD, water .m,a_y encourage mu .cle relaxatlon, thus reducing guarding around, joints and enhancing movemeet. It i' ,31],0 possible that pain relief was achleved 'by- the temperatur and p r ssure of the water on the skin .. 39 Although i,t is possible that SO[Rl,e benefits of aqua tic. p 11'Ys-~,ca1, therapy :lJl;a,y be- attributable 'to .'. ': arm... ' a-rer imm .. ersion al 0' l11e , :a previous randomized control! ,~d 'trial lin rheuma - old arthritis demonstrated superior effects I( f hydrotherapy over seated Immersion alone.' 10 Perhaps the most Important aspect of the aquatic environment is the buoyancy of 'the' water, rather than its W3,f mh, w bleh f'ed:u,ces lh.e 'w[eigI1t-b[f:c~_ring, SEre.· ses; oin '[he ~,owler' JIim'bs and 'rh,t'.·

P" 'w"'m'" 'oit'eiliO:' m-' . '0' ~-"" p- .. "J1I:j 11 '~~PtlF" .-:I"iliI'd'- jCitWi=c"t· ~V'cF"

::"'.:1 " I~ .. ~. - l~ ... ~.ji . ~> .. ~~ .. t1LJ_ ~·~Jl,IJ.~~ ~.1.1J..W,I.~ , 11Iirr1_W,!~ ::... ~ ill' . ~

e'xe:[!c-i'~e of th,e m,uscles and jll(illts than

". ul""~ ·t'~h:.;o ,Oi ~::ro 'i:-.. -- ....... oib--'II -

wO.· _);;,;1, 0 _lJ;:'[WJ'e ui: p:Ossl,l~e.,

T,o our kn,Q;\\Iledge, 'lIli~i :5 the fi.r,';t stu.'oy ,of 3,[Q u;,~tic IJ~lY:'ic3J ther~lpy th,al has. ,encQ'uf:"dl,g:led longo:m,ng :m ode .. :pe,nd.' ··nt a,qll~l m,e fh,e-ra.-P'Y :o.111owing Ices~ ~ulo:n, of the sIDlp,ervised pFogranl, :and, -inco-rpordle1d a. foUow~u.pper][od", . "'., , .paf1t of [ll.. ,interv[en,f,o:ol [OlU" pa.r-

'm-;: C,jil-)f''!l'I-l'iII- ',!,"IIi:t",t:!i; re-' l' 'il'Iii;et r--jill c'·~~d 1~'1iI"'!ii 't- 'h ti!:i b !li:::i.ll

IL:W,.,'. - ~ '," ,tIL IlL: ", . ¥--~~ ,,-"1.1 . ,'JJ.,!Ij,ci. _' ~ ILl •• : ',., L~' '_ .. :IIJ.,W, .', ,1~1 .: b . ,_I

,efil' ,of 011g0"" l;g theulpiY :fm,d exercj:: ... ~ . ,:elf-:managem, 'n t. -)rim"1cl1)~e~s priY'Ii.d.ed "Wl .. ·~'th-· ·d:,c .... t- .... -·,:le-d·:· 'W' ·:-'n-~'n- .. -·'e'lr"iIl 1"ir"ilII,·,r-iI"iU- C -1'O'-n' IS- Ion:'

"~'. .' .~Ld.rulJ..· ,'_ : '_' _,_' J:~ UJf ,Iy I~_'.· .. __ . _ ~,io.'. _ .. __

h,o-v, ' to ,perf 0,011, a:, ,lIan:i,e :p[:hy~cal t:be.r= ap'_' ex,eocises ind, ·pe,D-cl·.n.d,¥, as w.ll

1 dify~ '.' tl .

~- • -., ,- • , ---: • -_~I I""' ,----. • . - - . (. ---

,as ](),\-;v to 'm.o.' ,. •... or P'.rO,gteSS - lerr

P!i1-¥"-O't-.3 'n-i'iii ,.,III""\I!"'"o-r .... :~':'''''"'g··, "1'[0,', ' "Y.'- m' p .. ; 'Il'iQiffi' , , ':Jinld

~ VIl!JA.~Y'1 II~.~~·. U_U,1 . ~P._ ~', J, "_' . ~J"_"'''''.i. ~! €JI ','

giv'e,n w.rit[le,n d.hections on, conv-e,nien:ir.l,oc:c1JJ, p'oal< ,in wI-rich, to ex:er-c]se.

january 2007

A1-_-,~'L,O· .. 'l'II, .. h O-,lllllt7' '1~1'1I'1Ii~~' a· .db.'1 - ,Fio'i!FV""'1filill'"'"oi!"" ,;jIm"" IIr-Jij"I·g

U,J . _!II, ~_' . '_ D . Jh.1l.JIl~D __ '._ ~~,~ ~.ILIL~~ l~JL = l!~vj ~. I

parlilclpant~1 was 'varia'bf.:Ih~ , .... ,~, contint r. ~ d aquatic pill'" leal 'ill ,- [31~!} ill '-, -,

'nii!'li-ji " ~nl1.r ,grit- Ilp4JI- It 'o(n-~7...p ,n ,,",'iii"' 'i;j'ji' -~,-", '0' '0'

iIi"'!!;".~ '. -,;;;; ~'-'J ,{'!!JL ,~,,",,~!I." ,ill, I."" !!!i.;.c,,"," ill";' !!i..,W, , .. ",:, _ . iI:'!i.,. r.

average ~ It was not po'· sible to moniror control partlcipants at 12 W"- ks in the l):re'~ ent s,rwdy as most of [11 ··~011" trol group had commenc ':_ d aquatk;

'I, ,. ....,11 d' b -.tt ~ ~'-..j ,

pJJlYSU;iO, ' terapy ··:ll uus sta ie, ew-

ever, follow-up (without a control group) of the aquatic plly ~,ical therapv

am''ii "lP' "lit' +.'II"111~' ". 'if~ 1ftf1' e ."'Iii'p"p:,~ red 'if'O:i dem 'O:··'if'ilI .. ,

I~' ....... lL!: .: ..... !{iLl. U,lJjJ ~IL,' IPJiI _ ," '-_l'U.1!Ii.z, ... ,Ii.. Y'-r. 1 . ].' . Jjlllj

strare that benetn ... at, 6 weeks were maintaine d,.

title that of land,-based exercise l)iro~, srams the 111.Ci()e' .. ,.,.. of .~, I~ rer- ,3'""")e!d i_ xe rclse p,.rOgC,UllS is 'p,rOb(3,bly p(at ... '[:a.1:1' dependent ()11 adhere nee tOI the prescrib d exercises, '(jveo the' 31- mo .,'[ perfect: a.' .tendaace demonIra: '.' ... -. 'by' ,our pI3:mlcipa;n't' " d,ur~ng,

,.- 1']Ij!Ji, I·IL·' n[-,~II"'I:r Dr- ;00' p'·~'r; od ';'1' '·W·,;oj I~ "'10.111'

_I, ,iii..,. ,II .. ! blL·~.' .. Il' .. , , .... """ .11, ,. 'ii ,1.11,,', !if:tQ' IL_,~IL,

:POi" ;$,ib:- e [.0 e'v~llU:~l~;e the :1",ell,'110'[15]',:iil) 'bet~re :n ad]l,e:f.il~'nce and outCO'lll· '., Ii1 'I:hlis trial l' ,it is ,Hke~,Y' tJla: :Idll[·. -r ... ] .•.. e ':-, as ,enh,allu.~'Ie.d, by vi:rttle of '[h,le clos •. ·' ,D:lloiniroring a~:~·locia.'u:~d 'with l)31:rtiici'~ p:a'U,on in a. ·:lr,e':~'ear,c'[l study :and '~,ucL i'xtreu1,e.' 'Y' hJgb l,evells of :adb.efenc!-' ~~louJd :notc exp e;,ct,ed, m, th ' (:,,1 i' -~ iIC'id ", ;ttUng,., Thu.,.,:t--;~U~I '_ 'gj,c''''; ·tol maxi .. mil ' a,dl,e,:Fle:~]c.- :aJlC!' eseJ:l[l~d ,for su '": .. ,oe~ -, in. 'CltinillCaJ pra,lcti,cle.,

;'-n -tlin,g S!J ic:ui e'xerdse~:rlal d ,: ~~(lll:~ that, ate' :1': - b'tt_· e'~,r leasy '-10 a,cl ,". I: I. h;D.S 'b,~en "'-hown 'to mcrea~e' a,quiltlc ex)-r",' ci ~':c' :[~. ~ lh.ettntt iln pt)ople wi:th t_~Jn:llnti .. "_:w :fn additio.n! as peo/pIle :un IJ rove' :01 'lth,eir' a' '.iUty 'to O::.ercise in 'w.e' ,alqu~uic

I_:_.n,vir,oom.e.n-"i :~dh,eren,cle '[01- • :rc,ise

U· "'iI ;iI'-"iPiie,o'jl'i2';M!loC''''p;i'I''~,j!:!ig'·n- ~~ 'iil,;I]" iir m' "'l~f' )"00' '""fiIo·'t'

, __ ;~;l~lI.'l.·_ t_':il!-~.:J!l!I "_'IIblI,I'1Uk'b~ ..... \.;..~ u,. t_ !ll.l ,~_ ~'1,1 i .••. ILIJ.} .ILI."

,-::Jtf.-:cft],iC"tlCY :i:f.l.cludie' begitmEng slow:~y ·Willl lex:eil'''ise'<, 'th~l.t aXle' !easily ,aCCOlU"" P':~shLed,~ 11:ro,g,eSismg e\x,en;::'j,·,. p.r,agteUDS. :dow'-:" and :pro,vi,dilng, freqU;'ll_: '_ nCOllJ1Gl,gem,eo1t.,4,2 lOur prognu11 was d. -- ~ign'fld to ed,l);("(1rl!; .. ' llanir -i;~)an'~, about tbe a,pp.rrop:ri:a;~:: :p.ro!,,-re~\ion of aquatic ,el'[f;ftcises, I[bUS optiolizmg tl1 ~ abw1ty ,af people' to adjusl re8'i'~:~1'nc··· and adtvLnc'e' dle .1)rr,ogr3LDl1 'dlem~- ... ~v!e'~, Of' u1.odify it acuordhlg; 'tiO .. rmn p("Oll , I.'..

Ad' _ '_c,:~ .~' effects 3'· soclated with OiU:n"' aquatic pl,h,~'i\ic3:~, therapy ~:ntle'nren'UOI,n w'[ere :mlnoir and translent and 0,\1\_ ':11"' half of the p:~,r- j,clpa'- ts ....., p "n-'

n . d 0,01 adv ... ':, '.. . ..,.;, cts at aln.. . ,- s

.; xpecred IJ _,Ie' most frequent . c O':ID-' i1h U:1if "N"3.', aggravation ,of joint ~"",ylnl>' toms .. ·ith exercise. SODle partie i,p\~U1.t. also described back pain after commenci ng exercises; the ba ;. - k pain may l_,a·_ .... been related '[0 the

prompts that '[hey were gtven 'to lmprov _ ,-_ heir posture 311d ' 'p"mal pos :ltiolll while walking and exercls'lrr:-lf, hI [the pool,

.··.fur p'.fiog,r.;a,m, di' , not iavol :."e' til' U: o ~- any specifle exercise equipment OU11~ r than a, ,: tep, which i- ;31 I:. ature .' If mo .• ~ t, h ," drotherapy pool ,. Tbj.~, stud Ide ,jgn. '¥\'~Ir used "[10 fa,'Cillt:3,tl.' Ilarth:::j,paots.'nde,rstruld,ul,g of ,XI.}fcl~e ,PJlO':-_f"~S t,IOru in ,th.le :aQ,u:atic ,~nvi .. , 'l"'onnlle:1l'~ ill, ,01('1der 'tOI Un.[):rove' ,co'1ft .. , d,_:n~i=' ~t< weU a.s 'to .m;ax:Ulli'lle ~idll~'!D 'nee .0 dll€! .pilo',grant indCll'e'!1'" d"ntly' at a,loc:al :pool dllr.u1g fOIUo!w", Upl. Th,f USie!: of e1qllilJ'J," le.[l'[ (.ftil)'piers, bo -l~ j' :and ,ftoa'[~) Ican be ·beJ),efi,lc"ial fot' r·· s.i~·;£an(~e '£r.alni:n.,g: :in the wI,ter" ~Ind !.r~:a.te.:r s;tf1e.n!,.th ,gI3.b- -':" Dlh1:'l1(ha" e' 'b,~ _Jl obtain,e"', :m, Ollr .study' bad I Iqui,piftleDl been inlc,orponlted, in,to the .P',fo'gra:m,., 11111::' .faiel d13'[ quadr1- iC"P·:;:·. ,fi",.m,lo.ri', ,m.ttsc:i.le · .• r:fletn:gJth d:id n'i[ lnc(~,~r- ,-,:,ignffic;a,nt~r 'wit'h 'our .pir~ ,gf;IRl 81 ay' ll'rgtU: .fo':r tbe Ini = e,d fo'r ,e\quip01D.t. '~or [,hi' ,mu, 'ci~ie' grollpl :in I~H _,:rt'ru.l~ 'ld jj ,r,. :Ho' e' er' [lle -a.dditlo:n.al. b .:rn,efit·.·· 0".' eq,ui.p'.Dll[).'t .lDigI1't 'b·.' off .. set 'by incr-e:a.sed, .financial co; ts ,of ,thie' inU!'fV ,n'ttioill, OF' 'bly ,red'uc',e:d ongo:hl~'·. ,ad' 1 .. :ffliC .' to It: 1.·, :p'co'granl by pa:rth::, .. ip~lnts.

T~h·.:F·' ar.:- :31 :n,u~mber ,of limita·tio·ns of

I d -h I k- -" [

'. Ii -. -'" - l _'j'-' -.",. I ",_ I . . J ", • '"1'" " ( .f I • ,"j ~--

t~l _ pre- e.n~ ' .. r-1L_,1 _ y. ",. ,e 13,( i" 0.1 a I) ~l,-

C :bo IH, lo!l~,:P' Di""',ce' '.1 ·,Ur:~tted, ~I, ~·~b:1'l ~~.

b~:·' - '.' II ·d· "'.:','" .. - . '., ,i'I·'''' ,1 .... , ,- II '-~' Ih-I ~ .1 '.. ;~j, - ft· 'I" ,.-

,!lJn(~_ .' _ I,g,n.~ f_ lljU,CJJ,~, .ma,) . ,til e In IiJ

_: -, ..... d" .'t- "'" ·":tll· d: ' .. , '. ,I . "1til ~, .'''-1' . '.: TIl-.. ..

enc· '. _ IN"JJIC S ~U,· _' . 0 U _ COI,HC I,. .,. JUte

i;' I1'1I '. i ' d .,

:~,Olu,IO'::;,-'ull ,P' n,O(1I 'Vl3S S 10',rt, :aLn,_, 'U1

C ~'1'iF"1' '. lin, ~c. lroo" 'n "fll ]." - ·ill·O· .' H'i:!' il:-'lIJ- ,i"';~1' ,~:: IO:A'···, _

Ii =.lb. :Il"Jb~ ~ ~ .. , . .Il"~'UJ' __ 1."'_ ._: _H.:Jl ~ _: _.~~. liIi. ", ,'," , I~J

m'l,ch IOIQgr 'f periods 'are w~.mln'~_ d '£0 eWllruale :Iastmg tllea"ml,elJlJt eftie'c[> '.

f' - [- - '~ ~ 11 '.'

I I . ~- 2. • _. ~ - - I' ';', -~.. I "" " i" 'I"' ,_. I -. [' ," -~-. j' ":

Ull1 rnLlO, __ , ~:.le .. 0. < ,0 ... up perl,o,

~ .. ··'k-·~I""I ~ ,~" .,-, ~· .. 'ru ' .: - ;--1 t",\ ",,' '-'.',,: r

dIe ..... u ~il, t: on [rOi ,gm up IU eC~IILI ,e . .1,

.[i.1- ... d'in, constraints. R,e[a.t~,vle~~-' (eu': '0' our s~:ud,y p\a,:rtic:i._p(~ln' So pres .nted

,- '"iI,l, ~, ~,-", . "1'" I' '1-'·' .. ' .'~ '.' [-" lr : "

Wb.lll ~lmp! .' ~.~ fP',l1"lma:rb), I 1111.j I, wa-

not posstbl '~,o perform subgroup

,~, . 0-;11 "'-!'iil"li', ~ ~~''''I d - t- -, 1- -, e -,., - I' 'rr --''''0''-'-·-'-' "'. for

i{-~].~~_ .. ~!!i".,~. ILV '_" t,lff',mm,e Olh,C- I,m,es .If

'1, .',-, ,', "A·· 1- d m .. ,o._', r . 0·"A- I" . '" rat ,[, ·'!iii ,', .

nip .,', 311 _, xnee .',::.,," e,p,arn, -e,lly. Jill, is

posslb .. ~ .hat k 'JI]"e '0" ;'1, ". "1'11']-'- d h- Ip ·O'A·',

.' .' -iJ'" ·1 ,J A . ". l\rl.", ", "," .. !~ I'-,!.~ II,.~ ~ ~~, ~I .' :,

responded differently to' our aquatic

, '~-, .,",,, .. -tl'- :-."11", .. --.- -.',,,- '-.' '-, ... a, -, but the

];hl.ySl(:~ .Ill [~-lp'y pIFo,g,ra,m 1 J U _- - ~le

presen t Sll1l'~d,y d i.d, : = ot have sufficient POIW er to de teet such differences,

Th .• ·. q.: uestion remain 'I~, Oljlc~' '-0, whether

~JlIJ. . ~lIJ~· . ~, JLIl i I ~ !t1; ...:J g~ _ _ _ Jlll~ _._ _ ~

or.lrqll '.I~"'il ~.,.- 'p .. , hv ,; ii!"""~11 the Ii'i"-"'II' - . ''111;1' ~!i:l' I~ iii "i.'p ~ '0' 'r:'

~_II!J -, ~~._)'lJ ~ !I!.' .. ~ .. _. ,', .,' .JiI'~R, . ~WJt . .1l,,!N, . 11 ~,tJ! OilLJll _' ...... JI .. JJ} . -

I ~ ~ ~ , •

'i!'OI:-' ~ ",- 'Ifi'loifl ... b I.' . ···~d-: I physic .... ' III '['~l',e"IT""1Ii 'p'tll" fo i" 'iii"

!!J., j.!!i-.~~,u. ,'- .. : '!!;.;."_ ,~_Il.J Ji},,=,tl.ll,.~. , .Il ,tII,.), ,JI,

I - i - ., ··1~·'~1':( "lI1'~ 'IIt--:~l O'~ 1h.."'1-· ~, fa ,~~ if""" it'O'

-,_ . ~ '_':!! -<. r~,~, :_ - I , it!il]!,dll W, I" JIj; 1!Q! J.II.'~· ~. ~ Ii. II~ . ~~; . '.

d ;!I'IO'1 '·illl"iii·.~I[-··-"lIi'fi', . '1'-" .ld"~I,·,,[lm,,, · ..... '11 b"" .. '.'~!if

~, .'.!l,~ .nUl".:c ;JUIY 3i_ ,ul L~,O:n,~, .. 111J[l.1.

of '~1- vdrotheraov .O-"I-V·· IP';fr" ·~I"iI'IOID-rn, '. l~iV\P.~; _~,

. .' , ~, J' Ii - .. 1!l.Il.ll.. ,!t, iii" .. J' .- ""III, ,iI.II. ,d,.JI, _ ",-"~~,lt ""'" IIJ

1-, .... 11 ... I ·.Ir O"I(!'r a, I~rm-'based, >. tfl.'DO;-.' len-

~~~ l~'

'tiJi"liIU' '~l-' InO· :1,1:1JI~-lIinIFill ~I 'I I~t'ii;qr-:- 'p-~e"o,p"" ,#Jo 'JlIi-tr'~[-··~l .' ···.A:.,.

u Jl~1 I' '1' .l~ ,tllu' 6"~, I!,v,~ . '" .,.L '!W~ JI. ~I., . " ,l

[ho':; _' ~.'ld,ES m.a' h~r_ 1 b, e'.D :re~a tied

iI'O" 1- 'I~, ""'q--U"'ll'll"C p.1h'1{IfIIIJ'·.£'!a] 'r- 'l!..'e'f;C-"lI'pf't'·~'it.\£,'L

II, I 1.11,1, 11i~,I .. _;~,l.'- . ·J!-~l'~\_"';'~__c,lill-,- .I~ ·i llj,ll,~'

g'F.;ftn:1, -"on t,. ,nt in 'l:hlo e .p·ubU:sllleld tri~,

I G'· .-, h' .. t'· f- - d- ~

.. ,'" " " ' "-.', '.',' I . " " ", ,-,.," . " ,', . '" . ',' _. -

a .' '" '. .1 .. n, . "If! asSOCl2. lOll 0 qua, n-

c:'_:ps f m,ori :m,uscL,-' ,streng,tJl wilfl IJ!ilin S~V', ri ty an.'d 'p'_lysi,cal fanctilon fn IIA,_ ,JiI1J.,~7' ,j"ii' ;':e '~'~~'&n'-I-'- 't."::] til' (I:' :3.IQ: "1lI' ;altjc,.~

., "~ JJ I!l" II,,", '\.,.-i.}I';;:;;I!'io.. ,_y_ _!L _ _ .__ _ ~ .

~prolgr~rnlll~ rn,nC'iorpOI:rat~ 3j, Fiesis: anc:. trauling, rnl'te n_·it}-I' co~m.:pa.ra'b,~e '£0 'rha:t of bl'nd-ba'~ .. ·.-d, ,p~ro'Rmms., 'To! ·m~cr,elt.e r,t'Sii'~i[31nC_' for ,nl1tC:n,e strl~mlgltll- 'Imt>'; In th' '\'f;I'£I~r. ~'t mal be' neces:'3J1 [0, :fUIIF.·:Il1,I':IF' Idec:r-e;~lse' th,c' d"ep-th 0'--' 'I:m,:m-'r .t,on \~,_,ith, ,c~o,ed<'haiD 'f:x,e.rc:i;e', ~o

-Y-'8i:·.' ,f;'III, -~;;II'Iii'''" l'I"n" '~"'~I~IO· ·l!f.l"lin" C}"-'ft';e·. '~i;'~;I'~J...I!Jd·' p"',OI'~IL

. _ _"._ it ~i ~111~ I., 1lJ-~~I" . '._~ ['Ill. ,'_ i Jl1,. !.J'IJAil!L'\.o _' ." ~JI

~ ,

tion~l, or t'Oi b, .1C:Fla,-~ resi',lallC' fli'!om

t.urbul nc. bi)1 in,c:fleasi'n,g: speed, o:r cllLlIl~f~[c a:re'a, (W:,dl 'dl,e a.'ddtiti.on olf fli:P,I~~rs or- boo'£s) w~i.tll open.-chaio

i .. ' '~. ··I·'Cj Sf; ...• .Fllll1h,eF. s,[u,ldi.e.s of 3,qua tic

ph}!-""icaJ r.h,:_,OlPf S110uld: a.inl. [01 ~ fin,·

pro:,!'1l,am, ,con,'£e:o.'[ by .mIDtimizing til·us . o,f ~h,·.' h;ydfos'£atjc :and, hyd:r'o-dYl13fllic' propie,['t[ lei 10£ W3;-er ,wd t'hJU~'-, 'nh,l~ :p.''-[ .. ' :Fl~-'i"ll 'b'D,eJir, ,of ·a,quat~.lc [Olhy': lical 'Eh_ 'm,il" .fo.r peoplile ·wi·th II 11'"1 -.~ .. -ii'm-'--"b~ . .,- _ '~'lI' [0'[1,' I~t=i'~·r,'if""'h a'II'· "0""

~I _ rrr'l! ~. iIJ I" ! ~ 1Il"~ ._. ="_ 1Il.~!Io ~Q. '~" It ..

5h'Olldd b .. ·:_ 1 Idirec' .'.~ d. ~O: __ ' 'ard eVfdu:atill"i Itlt... Ich,l:m'C(lerisitics ,of .peo,pl~e wh_! fl.-"',pond to bmd,- a.nd, ,,'at·· (=

b"~I;P ·d· I ,v" 1f"'~1;' ..• :--_,_ .;]1- .ii·ifr 'i~' p-~,o" i~!C'.rb",~~ ,- b'··cli"ili[--

~ ,If]l'''1!i _ ....t1. . It '\",.111 .' ,lI!> - ,~II, = ;:11' ,;!;,"II\iJI',I, U, '!L. . . "Ii,.

jf~ '. 'r!' ojli-n 1:1 p' .. ' ~,~ lo·'f. "·X.·· .. ,,J:iI'f"Ii'""'~:·~' Ii"\,-~ .. :n'!bn,i;"~,'n- -,- 'iIil!]

",,- .. ,11. Li!i-i!j, __ ,_, _ . '!!..~ .,. < '!!....II.II!...-. ... - 1;,.. .Il,~i!t' I!i;.,,.,;!

are m ,re ,:~'Ui ,- a b[: f roup 7:1 .. "

r" I --I .

Conclusion

11, :' p.r. . nr sn ldy d monstrate ha'~ a (].." " I, k pir "~ ram o - a ,Ill' ,.' lc ph ,'~i~ '\''1,', re ~td" :i '11 small improv - menn in pain, : ·tiffin .,,' -]'11) srrenath. and qualiry of life 'ill p _" '1),1 ' wnn hip OA 'or knee t :,A compared 'with no intervenes '0,. A,I,:_'ua't::, ~ ph') sical th rap," i,' , us ful in~,:, rv nrion option for such people; 'nlan,,' nee 11- nav adhen .. 'to tho interv nno 1

d ,n·t.~ _" I nee UII,:-- "~U:I' , rv ls ' ,,'!f"rfiUlll

[Dlf' Hl nmsn Iii rid M s H e,)'lNlQo d p rovlded conr(leptlid@a/resiearch de,si:g n ~ 1[1 d wl~i'I' i'ngl. M r [:alay plrov~d d data co Itm C t":o n, .: nd IDrr H:ln .. main prov'ded d ta aln,.lllysis. Ms H!eywolod provided project mancgeime,_,_t and "und p rocure rnent, The au thors tha n k Kath ryn Ri:~<c h~ e Io r h er a ssls tarn ce wi. n d a'ta e n try, je nny G eyte noeek 'for he r 9 u ida nee'; :, n d th e Sunshine Hospitel and IWestern [Hosp~t !II pnys.iother,a,py depa trnent staff 'for their support.

The local Human Rese·arch Ethlics, Comrnltte e lapp roved! the study.

Th iSI n!S'e,lfC - ,. ~ in part", wa S pre's' 'nt@d at th e 47th An I Utd S[cient:~flic IM'.etiin. [of th AU:;ItnJ~ian RlheillJmil.'~ol!ogy Associua'tii'o,n/Rh eurnato,k~gy Healll h Prolesslcn oils ,A'~, sod aJi j on; Mia)' .2 2,-.2:5 i' 2005; IMiel b DiU me, Vile. '[cmi a, ,Au sn ,iBJ i :,.

Th ~ s study W'iS supported by I Nil, ilonal Arthrftiis, and I :;, Sit Ilols:_~le'I'~II[ ICondi~lions I~ m[pro,Yem ent 'G Ij,illljlt [rorn 'tlh' , "Us.'tJl',.lllt In Governmen Department o'f Heal t.h ill nd ,Agwlflr9'"

'This ,"dieif wen received Jonu'oPf' So' 2000, and WUS u((lep',ted Augus,t J' 1 t 2[00'0.,

DOli: ~ 0.252 2'1 pt], 2:010,6[000 6

Ref'@I,'enC",5

\'~ anh .'.;( .J, . , .. ,CI!CfCk KG,' r Uii~ ~ 1'2. I, 're" a~en·e uf ' '-1Ilt: 11 fll~)U~C dw~ ~e .'_''''(;'' in. a r.h "U 1:11' '" hlJ..O ,~~i a~ OU1(,p" 'twt: III p I1lC1: i cc. A 1~ n R1:1(!U IU ,D'l.'ii _ , ,0(' 2'6 '~I. . ~ ~I~' ~ 1.';:,':-:

_ _ _ • !II w. t ~ .. J! ,-,J. II!!

Z H';anl] I" rlJlJl~Ural ,D. '" ~j ni ,C_ ,a~ jn~llrul . ,~n ions ()f o"':[I=-oi:Bln:hrit~is i nd laging. _tl'l~l" RI.) "'tltUI Di ~. 1 [:~r··(" I :::,,:,:~.:.;.

_, '. 111I1f!' ric ~ n I

-:-[ W~llk r-uon te, J:""lvald K t ,rd .: ~. ~\+J,(;d:il'l"d m~ln~lg,emen If ' , JjjU/Ol~ ~Il 00' ~:,~ 1 · 93r(, -9 ,0.

.~

- O[ I" Jl' yt'. be ek J. E'~lideI:H~'C: .f 1,( _' fe :_'t~ C h~ '" dfotb 'r:a}l[y. Ph}J:slotl:J't!'J.·'~lJj ,~ 2!O02;~'::~ll'l- 5.29 ..

11 _'-O~~y 1]1 Itl~be rt J, ~'Ie,. in T. ',fony _,I[.

Dot;s ~ 'ydrolh~nl,p; '·l]lp,rJ· ve SU~'. ng;rh ~ nd ,h~ !~mc~d runcnon in patl nn ~ " Irh O'[CU ru1Jnili,: ::il randomt sed 'U ,i[roU"d trial " , ':mp~rill1g a ,g. m bas ed :and ~'I. ~ )'dLroth"'r~ :ilP')," - as . d strengthe rnl.1.n.g, IP:r ':g_-' Im+ R'be'u1-~~' Dls. 20031'6.2::,:1: 1162 -rn '~6: .

~" ..:-rh'e" U:!.r. . ,1ll1\lre~l:ig. IfiOJ . of ~.X' IC~ ~c _' 101 hrd fLI't _- c,nipry iln the I n!~U nfl[e'n~ , f ,--:- ste ,

~lil[h'['iI~ hi~ p" Cli,'~ ,R:eblfll.IJi1.. ~, )lA9;", ,':

2:;t',=22~:t

. ' (; ,Altlllllan It. : l~ucon IGr, _ :.:.ppc'l.rou1[11 D, et ~IL The All] dcaa r' .ollege of Rh lJmj~ulog)1 criteria fOI~ tb clas ,.i.fi:c~.u J1 and rep rtin,~, 0' o~lt,eo~wrthrit~ , I'- the h~p,. AI {blililt;'/s RIJ(!,llrnl• I' '\[ I;": :-,0"-,]11·.

'.[ Ua'~nho.rn,e G'I ,1,I:ir.!tw:lm-ds-Ol1 ~ :O,ay N .. A.

comparf on of r 1IJC' Assessment of I, .··Ulil U~y u_ llilt;' (' ··oL) with £'0 I oth (' eeneric ,uJiitr instrum nts, A,,,rl' ~t·e,"l. " I ~ ;3~:

U.

,. ,

.':', .. _ 'lL_tlnn T,i;' ooper ~~ Kin. ~~nJR, c[ al, i rcterm ~n~ln'l5 uf tJ lsa b~l i.~, W n osteoart h:r.i Us of he Ik nee, A "UJi R'b\ It U1: DiS.. 1''9 _:.: 52; ,-'~8,: - "'J',6' ,,}

• ~ r.iiIIiil.

I, 11-_11 K II' rJlJh~~1 'I[ J, :\1' llano j nc",,_ t,~Sl i drn;m.1ii i," , 1[~}JI1(Jiin II b~~jbJ!l-. '" r:]I-

s[ roke pu ii) nl[ ": rem.: bil1i[r ~ 't;l J id i," r nrl CO,I'[I pi~~fson ~',i~h lJ1Jea~I['1r111- ',"Id [[Jr.· ~ l~b:ysr

,I, .~,II'.~ ~: I 'II ['lilt, • f ~~ ~,!i: =-. _ ",,},i":,

Ii' Mall} , ,. I, ""~~~ • I 7' ~,. ,n •. ~ .}I -,~'U .......

,~',o t ~nlll~Ul1 :RS, lit:'rr.ru;:1I, "I .. , ~d.le~iIl,;:,~~I~r Ui~~ f~mro;'si:. Kl\'~. [11 time Ii b 1J:f]airmlen~· in ~nrdlw,.',.i u;i~I~1 W~IUt ~~ lUP" , Inl~ltirt" ,,-. ."'~[ 0' rllhri~'i-· ': ~~. ,"omp3'-" son \\ lin match d ron .rols ~-jng (.'In.ffic~m t.'e~'1 ,', RIJ 'u,'l]UJ/:': ,1'o~.J" -i' .''':';: I, I:

I, ::f~:,-1-'9 ' .

. ',1 p~ )t~si,~.cll'o D'~ lUchiard,on. ~ - TI1,e I[:i "led .. up ~Ind ~o": a '[I ~~,L of b . sic functional illOb.iJiq.r . : ,r fl""..ti I e Id,e:r:l' ~ iers 1ft s, J A Jil'~ .' '':),~-J, tr s DC_ ]1 Ic~ l~.(: W ,~- L: '.

(.ria~I=:

3 " " use f]"';t:I' '. d, 'VI ,~Opm1~[ 1111.

Ib; . J RI"e,r:t. fn,atol. [ . 97'; ~ 9,:

l: nualiY 2:007"

34 H:~lS5~J1 [l Dohe fj[:~ S, Mocken. S, Doherty ]\1,. Eft:ec~ of pi~;dn. reduction om, postural

. . d d" '"

s'\'\r:ay" propnocepnon, an q,[I~~ ,nce'ps

str ngd1 in sublects with knee oeteoaethrt-

Iil','", ,~I,- c- n,~-,,~. '~'i" D' 'I.. "olf~I')"6" '1- '. £"'2 .1?'8,'

Id". ,;('!I1U~ ,n_",eIAi,~~~ . ,,,~L _u!U.;:;.~' ,."11:-. -- "t" .... ' •

3,;, Mo elcy B~, 'O',M.~:Uey':K~ Petersen ,-'". et :~d. ,J\. controlled ~:ria~1 of arthroscopic surgery' fo.ll" csreoarthritts of the knee'. Pl ,1l11g1J l1tJ.e',L

2002,' . - 7''''8'-1 8'-8

' e- I· .. •· -I ',:,'1

• • ~. I" • Il

;:z:£:: 'D", , ,]'" "G-'D IJ,)', ad "." r'" ',"~;j' 'M' '~--, kel IIIi'll'

,,.)IU , ' ey ,f! ". '_., ,ncn, !er~on "I[;, ~ .e. "l~e, ,(;! ,~~

er :: 1., Effectiveness o.r manual p!~lY- ';~c,d thera P}l and exercise 'i n osteoarrhnus or the kn'~~': a f"JndOfl1ized; controlled trlllt A nn Inter« ,Me~i:., 2000;,1 32::m ~3 = 1-8 'ill -

,37 Hughes Hi Carr A.. l\, ,rnndomillz;ed'1 d-oubl,el.. blind, placebo-eon rolled tri~1.I: of glucosamine su~phate as an :ID:llll!lg,es:k in ostecarth riUs 0,' the kne e, ,/lbft.'u Ina~m,lo8J' .' ~002;41 :2~9 ,-284.

:3,8, Hrobjaresscn A1 Gotzsche :P'. '~:' the placebo powerless? Am, ~lnmdy,sj', '0 elmlcal 'trials CnnThpiruril!ljg placebo wi:ch no treatment. /V ,fj."rllJlJ c -lied" 200 1. :;34·4; 1 5'514, -1,602.

,39 Bender T! KaJulg.lm~Ue .l. B~U:n:t G"'. et al, llydrodiJera,PY, balneorherapv, ~;n.d spa treat rn~'nc in - pain management, ,llb,e,~J:w'}f,ce'"" t'Ol hlt 2005 ;,2:5: 220 ,_ 2.24.,

40 I ]';flU J.~ S.ke'vmgtun S, ,M:addi50:n P,. 'Ch:a rman K .. ).\, raudorujzed and ,co:f1r[~o.~~,ed trial

of h~i'ldfocherl.py in rhenmaroid arthritis, ,A,,~·t:1;,rflis Care ,/le;s. 199,G,:-S~: 2:(~~' - 2ru 5,.

,I GyU[[iC 'it' " , ',·;t3Jbrou'k~ :P'" Frahm-Templar M. ·Exercl. e-related goals. armd 5cl(~_['t:I!c~~,cr ~IS corretates of aquatlc exerce e irnl ind~viduals with anllri~:is,. A't"l,'hi,~,:i'tis C{I;~"€ R'(1Se'" 2003; 49,: ~06 -31 ,.

42 Nied R. ,Frru'lklin :0.,. Promoting and prescribing exercise ,f,or the eldedy-. A~':I~ ,[-:'J,I'JF Ptrysicia~1:~ .2002;,65: 4: 19 - 4,26 ..

Sign up to vote on this title
UsefulNot useful