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