Community Based Cool Water
Aqua-therapy for People with MS
Tania Burge MS Specialist Physiotherapist
Bristol & Avon MS Clinical Centre, North Bristol NHS Trust
Disclosures
Sanofi Genzyme
MedDay Pharmaceuticals
Background
People with MS, EDSS >5 resist challenging their balance
Aqua-therapy utilises the buoyancy and resistance properties of
water
PwMS are commonly advised to go swimming but rarely go
independently
An exercise training programme in water may be beneficial to
maintain and improve function during land based everyday
activities (Marinho-Buzelli et al 2015)
Aims
To develop a new service delivered at a local leisure centre to enable PwMS to exercise safely in cooler water (290) under the supervision of Specialist Physiotherapist and assisting staff
To improve balance in PwMS who find land based rehabilitation difficult
To enable participants to continue to attend and independently exercise at a suitable pool to self-manage their long-term condition
To train leisure centre staff to have a specialist knowledge of MS to enhance their ability to treat PwMS to maximise their function
Key considerations for partnership
working
Maintaining NHS standards in a community setting
Information governance (data storage, confidentiality)
Safe guarding (vulnerable adults)
Professional responsibility and roles (insurance, risk assessments for the aqua session and individual patients risk assessment)
Methods
Referrals: from the Specialist MS Physiotherapy service at BrAMS
Inclusion criteria:
Ambulant EDSS 6-7.5
Balance problems
Medically stable
Continent (bladder and bowel)
Able to follow instructions
Attend ≥ 4 sessions (5 session course)
Outcome measures
(pre and post course)
Outcome measure Description
Berg Balance Scale
(BBS)
14 items test 0-4 (0= can’t do,
4= normal performance)
Timed 10m walk
(10mTW)
Time (m/sec) and cadence
Timed Get up and Go
(TUG)
Dynamic balance. Sit to stand,
walk 3m/turn return and resit
ABC Balance confidence
scale (ABC)
Self reported balance capability
of 16 daily activities
Multiple Sclerosis Impact
Scale-29
Impact score physical
/psychological Cattaneo et al 2006
Hobart et al 2001
Patient pool contract
Agreement of the following rules when entering the pool:
Drink and eat breakfast before the aqua session
Inform us if you are feeling unwell, or there is a change in your MS
Abide by the safety and risk assessments of the pool
Entry and exit methods are the responsibility of the MS physiotherapist
Hire of the Pool
The Pool
Negotiation to use walking aids and
wheelchair/scooters on poolside
Access
Delivery
MS Specialist Physiotherapist led with support from
MS Assistant Practitioner and three swim instructors
Participants attended a 5-week course of 1
hour/week aqua-therapy, maximum group size of 10
On completion participants were invited to continue
to attend to independently exercise
Circuits
Warm up
20 circuit exercises based in 5 work stations for walking
and balance, upper and lower limb strengthening, core
stability and cardiovascular fitness
Use of equipment to assist with balance stability (floats)
and to increase the difficulty of the exercise (weights)
New Starters
Independent users
Group activity
Volleyball to work on multi-
tasking balance.
Results since starting the service
14 courses completed
92 participants taken part in the service (61 women)
Age range 24-72 years. Mean age 52 (standard deviation 9 years)
EDSS range 6-7.5
29% of the participants now return and exercise independently
Results
Outcome measure Mean before Mean
after
P value
Berg Balance Scale (BBS) 41.6 45.26 <0.0001
Timed 10m walk (10mTW) 23.9 (steps)
21.0 (Sec)
21.81
21.20
0.0001
0.0108
Timed Get up and Go (TUG) 23.7 18.55 0.0017
ABC Balance confidence
scale (ABC)
42.5 46.63 0.0013
Multiple Sclerosis Impact
Scale-29
63.2 (physical)
26.2 (Psychol)
58.76
23.25
0.0044
0.0432
Questions from the data
Is there a significant effect
after a course of aqua?
Were the therapy sessions in
later courses more effective
than earlier courses?
Is there a change at baseline
between those who
benefitted from therapy and
those who did not benefit?
Yes
No evidence of change in
effect for the later groups
No clear pattern of the 6
(7%) who did not benefit
Patient feedback
‘Brilliant course but hard. Enjoyed the social aspect and want to
come back and independently exercise.’
‘Great. Very positive thing to do. Feel the benefits – feel made to
realise that I can do more than I thought. Feel more positive and
really enjoyed the social aspect of the group.’
‘Enjoyed the course. I was scared initially of the water but
enjoyed it more than I thought.’
‘I was initially worried about starting the course but it went much
better than I expected.’
‘The overall benefit of continuing aqua therapy is evident in my
general well-being as well as my mobility, thus reducing in some
measure my call on other NHS services.’
The positives of social
interaction
Thank you
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