The winner of the evidence in practice award at our QuDos awards last November was the MS Aqua Research Team, comprising academics from the University of Brighton and physiotherapists at the Burrswood Hospital in Kent. We spoke to the team about their work and what it means for people with MS
Our work on aqua therapy actually developed from a desire to help physiotherapist collect more evidence for their work. We wanted to develop a standardised data collection tool that could be used across the UK to evaluate and audit MS physiotherapy services.
It is really important that physiotherapist services consider what information they need to demonstrate the outcomes, efficacy and efficiency of their services, and set about collecting the relevant data to inform the people who commission MS services. This way we can make sure we can help even more people with MS.
The Burrswood Data Collection Tool
We designed the The Burrswood Standardised Data Collection Tool (BSDCT) to collect anonymised data relating to physiotherapists services for people with MS.
We collected data from 100 people with MS who had received physiotherapy at Burrswood Hospital. They each received eight physiotherapy sessions. These included an initial assessment, six dedicated treatment sessions and a follow up assessment. Data included anonymised patient demographics, diagnosis, referral information, treatment details, outcome measures and service related information.
What we found
67 per cent of the people we studied had progressive form of MS, while 30 per cent had been diagnosed with relapse remitting. The majority were women, and nearly two thirds of people were between 40 – 60 years old.
77 percent of people were seen within four weeks of referral to the physiotherapy service and more than half of them were seen within two weeks.
Over three quarters of participants completed six sessions of aqua therapy A wide range of treatments were used with the four most common being: balance re-education/exercise, functional exercises, weight bearing exercise and active strengthening.
Our outcome measures showed an overall improvement in fatigue, health related quality of life and balance and gait.
Most interestingly, we found that aqua physiotherapy had a 19 per cent more positive response in improving balance and gait than conventional land-based physiotherapy.
84 per cent of people, who completed the course of eight sessions, said that they were motivated to continue with independent exercises and 73 per cent intended to continue with exercise at Burrswood Hospital.
What does this mean?
Our study gave us a great insight into the service we offer at Burrswood, and has allowed us to develop our service accordingly. However, we realise that more research is needed into the effectiveness of aqua therapy for people with MS. We’re continuing our research into the long-term effects of physiotherapy for people with MS. We hope our study will inspire other MS physio and aqua therapy teams around the country and internationally to collect and share data on their services.
In the past one of the main barriers to people with MS accessing aqua therapy has been heat sensitivity. Some people with MS find public pools can be too hot. Many people with MS find that heat can cause their symptoms to worsen. This might involve a build up of fatigue, blurred vision, loss of balance or a worsening of cognitive symptoms such as concentration or memory.
However, studies have shown no adverse effects when people with MS use pools with a temperature range of 25–35°C. Heat sensitivity can also be affected by the temperature outside, so people who experience heat sensitivity should exercise in facilities with good ventilation.
Strategies for managing heat sensitivity include:
- Exercising in a pool that is 25–30°C for people with minimal-to-mild physical disability, allowing vigorous exercise without excessive increases in body temperature
- Exercising in a pool that is 30–35°C for people with moderate-to-severe physical disability
- Ensuring good ventilation in the surrounding environment
- Maintaining adequate hydration
- Allowing regular short rests
What aqua therapy classes mean to me
Some of the people with MS who go to aqua therapy at Burrswood share their experiences
- “They gave me back the confidence in the water I had lost years ago.”
- “My balance has really improved and I’m going to keep it that way.”
- “Before I was diagnosed with MS, I had never even thought of physiotherapy before. I had never needed to see a physio before, but now they play such a big part in my life, I look forward to coming here each week and
- doing my physiotherapy, it is so important to me.”
- “The exercises are so much nicer in the water. They might be the same ones I do on land, but it feels so much better in the water.”
- “Aqua therapy can help you to stay strong and positive when you may not feel like it, really.”
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