Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Law SHY(1), Lau MHL(1), Chung HHY(1), Leung KKL(1)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital
Introduction :
Balance impairment and fear of fall are commonly observed in stroke survivors. Literatures reported that hydrotherapy is effective in enhancing balance and gait in stroke patients. However, there is limited evidence on the effects of hydrotherapy on sensory integration, balance confidence and advanced postural control in chronic stroke patients.
Objectives :
To investigate the effectiveness of a short-term adjunct hydrotherapy program in improving balance, functional mobility and balance confidence in chronic stroke patients.
Methodology :
Chronic stroke patients with disease onset time of at least 6 months, who could walk without manual assistance, were recruited into the hydrotherapy and control groups from the out-patient physiotherapy unit of Kowloon Hospital. Contraindications of hydrotherapy were screened for the hydrotherapy group. A six-week training program was provided to both groups. The control group received 60-minute conventional land-based physiotherapy training three times a week. The hydrotherapy group received an additional 30-minute hydrotherapy training twice a week. The hydrotherapy training program consisted of exercise with maximal voluntary excursion, perturbation exercise, as well as limbs control and strengthening exercise. The balance ability of the participants was evaluated by the Berg Balance Scale(BBS), Time Up and Go Test(TUG), Sensory Organization Test(SOT) and Cantonese version of the Activities-specific Balance Confidence(ABC-C) scale. Assessments were conducted at the baseline, upon completion of the program at week 6 and follow up at week 12. Paired samples t-test and two-way repeated measures ANOVA were used to analyze the treatment effects.
Result & Outcome :
Sixty-four patients were recruited (Hydrotherapy group n=46, mean age=47.8+/-13.7 years old; control group n=18, mean age=55.0+/-12.5 years old). There was no significant difference in demographic characteristics and baseline parameters between two groups. Both groups demonstrated significant improvement in all outcome measures, except vestibular ratio in the control group, upon completion of the training program. The improvement was maintained at the 12-week follow up. Greater improvement was observed in all outcome parameters in the hydrotherapy group, with significant between-group difference found in ABC-C scale (Hydrotherapy group 8.48+/-7.37%; control group 4.13+/-6.18%; p=0.03) and vestibular ratio of SOT (Hydrotherapy group 0.054+/-0.093; control group 0.001+/-0.020; p=0.02). The results of this study suggest that hydrotherapy can be an effective, enjoyable and safe tool to enhance postural control, functional mobility and balance confidence in chronic stroke patients. Implementing an adjunct hydrotherapy program to stroke patients in the clinical setting may provide additional benefits in postural control enhancement and fall risk reduction, especially in challenging situations where sensory information is inadequate or conflicting.
