2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Aquatic Physiotherapy Group
and fear-avoidance, and physical deconditioning. Clinical
measurement and video analysis are used to highlight this
aquatic physiotherapy approach.
Land-based versus pool-based exercise for people
awaiting joint replacement surgery of the hip or knee:
results of a randomised clinical trial
Gill SD, 1,2 McBurney H, 1 Schulz DL 2
1
School of Physiotherapy, La Trobe University, Bendigo, 2 Barwon
Health, Geelong
The aim of this investigation was to compare the preoperative
effects of multi-dimensional land-based and pool-based
exercise programs for people awaiting joint replacement
surgery of the hip or knee. A randomised single-blinded
trial was conducted in a physiotherapy gymnasium or
hydrotherapy pool. Eighty-two patients were allocated to
either a land-based (n = 40) or pool-based exercise program
(n = 42). Each six-week program included an education
session, twice weekly exercise classes, and an occupational
therapy home assessment. Participants were assessed
immediately before and after the six-week intervention then
8 weeks later. Primary outcomes were pain (WOMAC),
self-reported function (WOMAC), and patient global
assessment. Secondary outcomes were performance-based
measures (timed walk and chair stand) and psychosocial
status (SF36 MCS). Pain was also measured before and
after each exercise class on a 7 point verbal rating scale.
Although both groups demonstrated improvements in pain
and function following the interventions, there were no
post-intervention differences between the groups for the
primary and secondary outcomes. The pool-based group
had less pain immediately after the exercise classes. Multidimensional
land-based or pool-based interventions appear
to be beneficial in those awaiting joint replacement surgery
of the hip or knee. Pool-based exercise might have a more
favourable effect on pain immediately after the exercise
classes.
Aquatic physiotherapy in sport: considerations for
measuring effectiveness, integrating evidence into
practice and developing targeted programs
Heywood SE
The Melbourne Sports Medicine Centre, Melbourne, Carlton Football
Club, Melbourne, Sunshine Hospital, Western Health, Melbourne
A pragmatic pilot trial assessing the effectiveness of an
aquatic physiotherapy program in a group of elite athletes
was carried out. The content and focus of the intervention
was varied and individualised with up to ten participants
(18–28 years) in each session. The primary aim of the
aquatic physiotherapy session was to address trunk control
and pelvic stability. Secondary aims were individualised
and included specific musculoskeletal or post-operative
rehabilitation, stretching, plyometric exercise or deep water
running. Once a week for 6 weeks measures including
pain, strength and range of movement were taken poolside
before and after the aquatic physiotherapy intervention.
Aquatic exercise is commonly described as less loaded
but the unstable properties of the environment are often
underestimated particularly with regard to rotational forces.
Consideration must be given to the starting position, base of
support or points of fixation for each exercise in conjunction
with hydrostatic and hydrodynamic factors including the
plane of rotation, weight bearing, speed, surface area and
direction of movement. Monitoring trends and changes in
objective measures can assist with ensuring that the content
of the aquatic physiotherapy session is more targeted. A
combined format of group exercise and individualised
exercise can be effective. The challenge in the area of
aquatic physiotherapy in sport is to develop specific aims
for the intervention, to consistently measure outcomes and
to integrate land based and aquatic based evidence into
practice.
Considerations for discharge planning in aquatic
physiotherapy-facilitating self-management and
independent aquatic exercise in chronic disease:
a pilot trial
Heywood SE, 1 Cross EA, 1 Dodds KJ, 1 Logan AD, 1
Bramley RE 2
1
Sunshine Hospital, Western Health, Melbourne 2 Eastern Health,
Melbourne
The aim of this project was to identify barriers to,
and subsequently trial a structure that would facilitate
independent aquatic exercise following discharge from
aquatic physiotherapy in a community based rehabilitation
setting. Preliminary data collection involved a phone
survey post discharge from the standard 6-week aquatic
physiotherapy intervention (n = 16). One month after
discharge 62% of patients were still participating in some
form of aquatic exercise. Insufficient access to transport was
determined as the principle reason for non-attendance. A
care plan was developed prompting aquatic physiotherapists
to classify their patients early in the rehabilitation phase
into one of three sub-groups: aquatic likely (AL): those
with good resources, support and understanding of their
condition; aquatic possible (AP): those with some issues
regarding transport, support or understanding; and aquatic
assist (AA): those who would require a trained carer either
in the pool or poolside to assist with mobility or changing.
Over a period of 8 weeks the care plan was trialled with
a new group of patients (n = 20). The 6-week intervention
was reduced to 5 weeks, with patients offered a bonus
week of therapy only after they agreed to attend and trial
a community pool independently. Outcomes measured
during this trial include percentage of patients continuing
independent aquatic exercise at 1 month post discharge.
There is scope to monitor the impact of this project on rereferral
rate to aquatic physiotherapy in the future.
The business of aquatic physiotherapy
Howell DH
Ergogym, Phillip ACT
This presentation will discuss some of the requirements to
run a successful aquatic physiotherapy practice. The aquatic
environment offers a physiotherapist a unique marketing
opportunity, specifically it offers a point of difference in
service delivery. The diversity of the environment also
offers a range of challenges and special requirements. Topics
included will be: how to optimise the aquatic environment
without compromising safety and service delivery; working
and communicating with third party payers including
compliance with their requirements; communicating
outcomes and other marketing opportunities; use of APA
resources and mentors.
The e-AJP Vol 55: 4, Supplement 3