2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Aquatic Physiotherapy Group
room facilities, staff assistance and modes of pool entry.
Water-based exercise is an effective alternative to landbased
exercise and is well accepted in people with COPD
and physical co-morbidities.
Examining compliance, barriers and facilitators to
ongoing aquatic exercise post discharge from hospital
outpatient aquatic therapy
Phillpotts W, 1,4 Cornwell P, 1,2 Haines T 1,2,3
1
Princess Alexandra Hospital, Brisbane 2 School of Health and
Rehabilitation Sciences, the University of Queensland, Brisbane
3
Department of Physiotherapy, School of Primary Health Care, Monash
University, Melbourne 4Sinnamon Village Day Therapy and Spa,
Wesley Mission Brisbane
The purpose of this study was to determine the level of
compliance with a continued aquatic exercise program
following discharge from a limited hospital outpatient
aquatic service, and to discover patient perceptions of
the barriers and facilitators to ongoing aquatic exercise
in the community. A cross-sectional telephone survey
comprising both closed and open-ended questions was
conducted. Participants were 25 people who had attended
a minimum of 6 outpatient aquatic physiotherapy sessions.
Self-reported compliance with continued aquatic exercise,
and descriptions of barriers and facilitators to this were
recorded. Responses to open-ended questions were recorded
verbatim and thematically analysed by investigators. Eight
out of 25 participants were found to be continuing with a
community-based aquatic exercise program as instructed
(32%, 95% CI 17–52%). A range of barriers and facilitators
were identified. Major themes for non-compliance included
reduced perception of therapeutic outcome from aquatic
physiotherapy and external constraints (for example
transport difficulties and cost associated with access). The
central theme for continued compliance was a perceived
positive outcome of aquatic physiotherapy combined with
ready access to a heated pool. Increasing compliance of
ongoing aquatic exercise post discharge from an aquatic
therapy program may require greater emphasis on educating
patients as to the benefits of ongoing participation.
Pregnancy-related pelvic girdle pain
Pierce H
Becoming a mother is one of the most significant
and challenging events in the life of a woman. The
musculoskeletal changes of pregnancy are secondary to
the requirements of postural adaptations for increased
anatomical space and increased pelvic joint mobility in
preparation for parturition. Pregnancy-related low back
pain and pelvic girdle pain is pain of musculoskeletal origin
that is experienced in the lumbar and/or sacroiliac area
during pregnancy or in the immediate postpartum period.
Pain may also occur in conjunction with or separately in
the symphysis pubis. At least 50% of women experience
low back and/or pelvic girdle pain during pregnancy. The
aetiology of pain remains unclear; although it is most likely
to be biomechanical, arising from asymmetrical movement
or positioning of the pelvic joints; and altered pelvic
girdle biomechanics secondary to altered neuromuscular
control. European guidelines recommend that the most
effective form of management is exercise. Water exercise
can be encouraged as safe during a healthy pregnancy with
numerous physiological benefits when compared to land
based exercise. A pregnant woman who has pelvic girdle
pain, however, may experience exacerbation of symptoms
because of the destabilising effects of immersion and the
potential ‘pain masking’ that can occur. An understanding
of the defining characteristics of pregnancy-related pelvic
girdle pain will assist the therapist in aquatic management
of this client population.
Cardiovascular autonomic function during head-out
water immersion
Pöyhönen T, 1,2 Hautala A, 3 Keskinen K, 2 Kyröläinen H, 2
Tulppo M 3
1
Kymenlaakso Central Hospital, Kotka, Finland; 2 University of
Jyväskylä, Finland, 3 Rehabilitation and Research Centre Verve, Oulu,
Finland
The purpose of this study was to investigate the
association between autonomic regulation (sympathetic/
parasympathetic) and head-out water immersion (WI).
Sixteen healthy females (33 ± 9yr) were seated on the
patient elevator chair on the poolside (27ºC) and immersed
to the neck to thermo neutral water (35ºC). Cardiovascular
autonomic function was assessed by measuring R-R intervals
and analysing the heart rate (HR), low (LF, sympathetic) and
high (HF, parasympathetic) frequency spectral components
of HR variability at baseline on dry land (5min) and during
WI (5min) were analysed. Participants were breathing at
a constant rate of 25Hz. Blood pressure was measured for
both conditions. The mean HR decreased from 72 ± 6 to 64
± 7 bpm (p < 0.001) during WI. The HF power increased in
all persons during WI from 5.4 ± 0.9 to 7.1 ± 0.9 lnms2 (p <
0.001). LF power did not change during WI. Systolic blood
pressure decreased from 108 ± 12 to 102 ± 10 and diastolic
blood pressure from 66 ± 8 to 60 ± 9 mmHg during WI (p <
0.05 for both). There were large inter-individual differences
in HR response during WI (from +5 to-20 bpm). The change
in HR was associated to the LF level of the R-R intervals
on dry land (r = 0.54, p < 0.05). Persons with high LF level
on land had larger decrease in HR than those with low LF.
The change in HR was not associated to HR or HF power
on land. Water immersion in thermo neutral water results in
an increased parasympathetic (vagal nerve) activation. The
most evident decrease in HR during WI occurs in persons
with high sympathetic outflow.
Neuromuscular function during therapeutic knee
exercise in water and on land
Pöyhönen T, 1,2 Keskinen K, 1 Kyröläinen H, 1 Hautala A, 3
Savolainen,J 2 Mälkiä E 1
1
University of Jyväskylä, Finland; 2Kymenlaakso Central Hospital,
Kotka, Finland; 3 Rehabilitation and Research Centre Verve, Oulu,
Finland
The aims of this study were to compare muscle activity and
resistive drag forces during knee extension-flexion exercises
while barefoot and while wearing a hydro-boot (increased
frontal area) both in water and on dry land (isometric /
isokinetic force production). Eighteen healthy persons (10
women, 8 men) performed knee extension-flexion exercises
while seated on an elevator chair in hydrotherapy pool.
Isokinetic and isometric forces were measured with a
dynamometer on dry land. The electromyographic (EMG)
activity of the quadriceps and hamstring muscles was
recorded. The underwater drag for the range of motion was
calculated by using the general fluid equation. The underwater
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