Effect of hydrotherapy in the rehabilitative treatment of

Effect of hydrotherapy in the rehabilitative treatment of Multiple Sclerosis (MS) Volanti P, Scialabba G, De Cicco D. Neurorehabilitation Unit Fondazione Salvatore Maugeri, IRCCS P. O. “SS. Salvatore” – Mistretta (ME) May 25, 2010

Background Ø Despite major advances in MS care and disease modifying therapies, no longer term benefit on disability has yet been demonstrated Ø The supportive and symptomatic management provided by multidisciplinary rehabilitation programmes remain the mainstay of treatment

Aim of the study Ø 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 Ø 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 Ø The Control Group (n=28) received conventional physiotherapy twice a day, five times per week, for 2 consecutive months Ø 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 At baseline, and at the end of the rehabilitative treatment, were evaluated: Primary outcomes Ø Ø Impairment and disability (EDSS and FIM scores) Quality of life (Mc. Gill Qol-SIS) Secondary outcomes Ø Spasticity (Ashwort scale) Ø Pain (Visual Analogue Scale, VAS) Ø Fatigue (Fatigue Severity Scale, FSS) Ø 10 -mt walking time (sec) Ø Muscle strength (manual muscular test, MMT) Ø Respiratory function (spirometric parameters)

Table 1. Demographic and clinical characteristics of groups at baseline Control Group (n=28) Hydrotherapy Group (n=32) p 41, 5 ± 8, 7 45 ± 6, 6 ns 15/13 16/16 ns 6, 3 ± 0, 2 6, 2 ± 0, 2 ns 83, 4 ± 12, 5 55, 4 ± 13, 9 85, 7 ± 9, 4 56, 6 ± 9, 8 ns 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 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 (Mc. Gill Qo. L-SIS) 5, 7 ± 1, 1 5, 4 ± 1, 4 ns Age (years) Sex (M/F) EDSS (0 -10) FIM ØTotal score (18 -128) ØMotor score Ashwort score (ASH, 0 -4) Muscle Strenght (MMT) ØAASS (0 -70) ØAAII (0 -70)

Results-1 FIM scores 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 before treatment FIM scores after treatment p 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 p=ns FIM scores

Results-2 EDSS scores EDSS p=ns Ø p=ns At the end of the two months of treatment, no significantly changes in EDSS scores were reported in the two groups

Results-3 Quality of life (Mc. Gill Qol-SIS) MQOL-SIS Ø MQo. L-SIS before treatment MQol-SIS after treatment p 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

Results-4 Secondary outcomes p=ns p<0. 05 Ashwort score VAS scores for pain before and after treatment Ø 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. Ø No statistical differences were reported in other secondary outcomes (fatigue, muscle strength, 10 -mt walking time, respiratory function), for both control and hydrotherapy group

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