Effect of hydrotherapy in the Effect of hydrotherapy in the rehabilitative treatment of rehabilitative treatment of

Multiple Sclerosis (MS)Multiple Sclerosis (MS)Volanti P, Scialabba G, De Cicco D.Volanti P, Scialabba G, De Cicco D.

Neurorehabilitation UnitNeurorehabilitation Unit Fondazione Salvatore Maugeri, IRCCSFondazione Salvatore Maugeri, IRCCSP.O. “SS. Salvatore” – Mistretta (ME) P.O. “SS. Salvatore” – Mistretta (ME)

May 25, 2010

Background

Despite major advances in MS care and disease modifying therapies, no longer term benefit on disability has yet been demonstrated

The supportive and symptomatic management provided by multidisciplinary rehabilitation programmes remain the mainstay of treatment

Aim of the study

To evaluate and compare the efficacy of conventional physiotherapy and hydrotherapy on impairment, disability, and quality of life of MS patients

Materials and Methods-1

Sixty patients affected by secondary progressive MS with mild to moderate disability (Expanded Disability Status Scale–EDSS scores≤6.5), referred to our Neurorehabilitation Unit, were randomly assigned to two groups, and matched for age, gender, EDSS and Functional Indipendence Mesaure (FIM) scores

Materials and Methods-2

The Control Group (n=28) received conventional physiotherapy twice a day, five times per week, for 2 consecutive months

The Hydrotherapy Group (n=32) also received conventional physiotherapy, as well as 45 min of water exercises (at 32 C) 3 times per week, for 2 consecutive months

Materials and Methods-3

Primary outcomes

Impairment and disability (EDSS and FIM scores)

Quality of life (McGill Qol-SIS)

Secondary outcomes

Spasticity (Ashwort scale) Pain (Visual Analogue Scale, VAS) Fatigue (Fatigue Severity Scale,

FSS) 10-mt walking time (sec) Muscle strength (manual muscular

test, MMT) Respiratory function (spirometric

parameters)

At baseline, and at the end of the rehabilitative treatment, were evaluated:

Table 1. Demographic and clinical characteristics of groups at baseline

Control Group (n=28) Hydrotherapy Group (n=32) p

Age (years) 41,5 ± 8,7 45 ± 6,6 ns

Sex (M/F) 15/13 16/16 ns

EDSS (0-10) 6,3 ± 0,2 6,2 ± 0,2 ns

FIMTotal score (18-128)Motor score

83,4 ± 12,555,4 ± 13,9

85,7 ± 9,456,6 ± 9,8

ns

Ashwort score (ASH, 0-4) 1,7 ± 1,1 1,8 ± 1,2 ns

Pain (VAS, 0-10) 4.8 ± 1 5 ± 0,9 ns

Fatigue (FSS,1-7) 5,1 ± 0,6 5,2 ± 0,7 ns

10-mt walking time (sec) 17,3 ± 5,1 19,2 ± 7,9 ns

Muscle Strenght (MMT)AASS (0-70)AAII (0-70)

66,7 ± 5,3 56,5 ± 11,5

66,3 ± 4,8 58,7 ± 10,1

ns

FVC (%) 97 ± 6,9 101 ± 13,2 ns

Quality of life (McGill QoL-SIS) 5,7 ± 1,1 5,4 ± 1,4 ns

Results-1 FIM scores

1836547290

108126

Before After

Control Group

HydrotherapyGroup

FIM scores before

treatment

FIM scores after

treatmentp

Control Group 83,4 ± 12,5 93,6 ± 15,4 <0,001

Hydrotherapy Group 85,7 ± 9,4 99,8 ± 10,8 <0,001

p ns <0,05

At the end of the 2 months of rehabilitative treatment, the Hydrotherapy Group improved significantly in disability, as assessed by the Functional Independence Measure (FIM) scores, compared to the Control Group

FIM scores

p=nsp<0,05

Results-2 EDSS scores

0

2

4

6

8

10

Before After

ControlGroup

024

6

810

Before After

HydrotherapyGroup

At the end of the two months of treatment, no significantly changes in EDSS scores were reported in the two groups

p=ns p=ns

EDSS EDSS

Results-3 Quality of life (McGill Qol-SIS)

0123456789

10

Before After

ControlGroupHydrotherapyGroup

MQoL-SIS before

treatment

MQol-SISafter

treatmentp

Control Group 5,7 ± 1,1 6,1 ± 1,4 ns

Hydrotherapy Group 5,4 ± 1,4 6,8 ± 1,5 p<0.05

At the end of the two months of treatment, only the Hydrotherapy Group improved significantly in quality of life

MQOL-SIS

Results-4 Secondary outcomes

0

1

2

3

4

Before After

Control Group

HydrotherapyGroup

02468

10

Before After

Control Group

HydrotherapyGroup

At the end of the two months of treatment, the Hydrotherapy Group also showed a larger improvement on spasticity (Ashwort score) and pain (VAS), compared to the Control Group.

No statistical differences were reported in other secondary outcomes (fatigue, muscle strength, 10-mt walking time, respiratory function), for both control and hydrotherapy group

Ashwort score before and after treatment

VAS scores for pain before and after treatment

p=nsp=ns

p<0.05p<0.05

Conclusions

Adding hydrotherapy to the conventional Adding hydrotherapy to the conventional physiotherapy program improve function and physiotherapy program improve function and quality of life, and reduce spasticity and pain, quality of life, and reduce spasticity and pain, in patients affected by secondary progressive in patients affected by secondary progressive multiple sclerosis with mild to moderate multiple sclerosis with mild to moderate disabilitydisability