Development of Body Function Evaluation Tool for Aquatic Rehabilitation Therapy

Abstract

Introduction: Aquatic rehabilitation therapy is proving to be one of the modalities of choice for neurologic, orthopedic and other conditions. By means of the biophysical properties of water such as buoyancy, hydrostatic pressure, viscosity and cohesion, the effects of reduced joint loading, prevention of venous stasis and muscle strengthening can be obtained in the pool. In order to know whether the body function in the water can be converted to the body function on the ground, an evaluation tool for the body function in the water is needed. However, there have been few commonly accepted body function evaluation tools for aquatic rehabilitation therapy. The aims of this study were to develop an evaluation tool for aquatic rehabilitation therapy and to investigate correlations between the newly developed tool and the on land body function scores such as Modified Bartel Index (MBI) and Medical Research Council (MRC) sum score.

Methods: Patients with hemiplegia (traumatic brain injury and stroke) and spine injuries (spinal cord injury and spine fractures) treated at Labor Welfare Corporation Incheon Hospital from January 2012 to May 2017 were retrogressively recruited. Their data on aquatic performance, manual muscle testing (MMT), and MBI were recorded for analysis. The scores of MMT were transformed into MRC sum score. In order to develop a body function evaluation tool for aquatic rehabilitation therapy, the 16 items related to swimming in the existing aqua evaluation tool were removed. The Exploratory Factor Analysis was used to categorize the remaining 21 items from the existing aqua evaluation tool. Spearmanns correlation analyses between the developed evaluation tool and modified Bartel index as well as MRC sum score were conducted to compare underwater and on the ground body function.

Results - Data for 95 patients (F = 10

M = 85) was included in this study. 25 Patients presented with brain lesion and 70 patients presented with Spinal injuries. Mean age of all the patients was 53.4years, with the youngest being 27 and the oldest being 73years old.

A body function evaluation tool for aquatic rehabilitation therapy which consists of 21 items was newly developed. Three categories of the assessment tool were identified. The three categories were related to altering the center of gravity, basic functional activity, and progressive basic functional activity. These activities were rated at four levels from zero to three. The sum of the scores in the developed evaluation tool showed a strong correlation with the sum of the MBI (r = 0.636, p = 0.000). The sum of the developed scales was also correlated with the MRC sum score (p = 0.01). However, the strength of the correlation was weaker than that of MBI score (r = 0.298).

Conclusion: The evaluation tool developed in this study could be used not only to record the progress of aquatic rehabilitation therapy but also to study that the improvement of physical function in water which can be transformed into improvement of physical function on the ground.

Key Words: aquatic therapy, halliwick, physical function, evaluation