Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra, Spain.
Physiother Res Int. 2024 Oct;29(4):e2141. doi: 10.1002/pri.2141.
Aquatic therapy (AT), though potentially effective, lacks studies on clinical efficacy in patients with spinal cord injury (SCI). A recent study analyzing interviews with rehabilitation professionals on its clinical application reported that the scarce evidence of AT benefits was one of the actual barriers to its successful integration into clinical practice. We seek to provide evidence by comparing independence in activities of daily living (ADLs) and functional ambulation capacity in patients following rehabilitation which included AT and matched controls who followed rehabilitation without AT (non-AT).
Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM-III), Walking Index for Spinal Cord Injury (WISCI-II) and its minimal clinically important difference (WISCI-II/MCID) were assessed. The AT group followed the Halliwick concept. We performed nonparametric nearest-neighbor k:1 matching for age, time since injury to admission, FIM at admission, level of injury (paraplegia/tetraplegia), completeness and cause of injury (traumatic, non-traumatic). The rehabilitation program comprised four daily hours of intensive treatment from the multidisciplinary team. Both groups received the same total number of rehabilitation hours at the same specialized clinical center and were admitted to follow inpatient rehabilitation within 2 months after injury.
A total of 29 patients with SCI who followed AT (admitted between 2017 and 2023) were compared to historical matches selected from 551 inpatients with SCI (admitted between 2014 and 2023). For k = 1, the groups showed no significant differences in gains, efficiency, or effectiveness in FIM and SCIM-III; significant differences were observed in WISCI-II gain (p = 0.018) and WISCI-II efficiency (p = 0.046) in favor of the AT group; the proportion of patients achieving WISCI-II/MCID was significantly higher for the AT group (75.9% vs. 48.3%) (p = 0.030). These results were confirmed for k = 2.
The AT group performed similarly in independence for performing ADLs and significantly better in ambulation than the matched historical controls.
水疗（AT）尽管可能有效，但缺乏关于脊髓损伤（SCI）患者临床疗效的研究。最近一项分析康复专业人员临床应用访谈的研究报告称，AT 益处的证据不足是其成功融入临床实践的实际障碍之一。我们试图通过比较接受包括 AT 的康复治疗和未接受 AT（非 AT）的康复治疗的患者在日常生活活动（ADL）独立性和功能性步行能力方面的差异来提供证据。
评估了功能性独立性测量（FIM）、脊髓独立性测量（SCIM-III）、脊髓损伤步行指数（WISCI-II）及其最小临床重要差异（WISCI-II/MCID）。AT 组遵循 Halliwick 概念。我们对年龄、损伤至入院时间、入院时 FIM、损伤水平（截瘫/四肢瘫）、完整性和损伤原因（创伤性、非创伤性）进行了非参数最近邻 k:1 匹配。康复方案包括由多学科团队每天进行 4 小时的强化治疗。两组均在同一专业临床中心接受相同数量的康复治疗总时间，并在损伤后 2 个月内入住住院康复。
总共比较了 29 名接受 AT（2017 年至 2023 年入院）的 SCI 患者与从 551 名 SCI 住院患者（2014 年至 2023 年入院）中选择的历史匹配患者。对于 k=1，两组在 FIM 和 SCIM-III 的增益、效率或有效性方面没有显著差异；在 WISCI-II 增益（p=0.018）和 WISCI-II 效率（p=0.046）方面，AT 组有显著差异；AT 组达到 WISCI-II/MCID 的患者比例明显更高（75.9% vs. 48.3%）（p=0.030）。k=2 时得到了类似的结果。
AT 组在 ADL 独立性方面表现相似，在步行能力方面明显优于匹配的历史对照组。
