Güeita (2010) aquatic therapy and Multiple Sclerosis (spanish)

Abstract
Introduction. Aquatic therapy has been used for many years for the treatment and management of various neurological conditions, as in the case of MS, based primarily on the principles of fluid mechanics. Ancient civilizations (Egypt, Greece and especially Rome) developed and distributed water use for therapeutic purposes. It was after World War 2 when it streamlines its use, acquiring a place in medicine, especially in the treatment of major neurological deficits, as in the case of polio. The aim of this review was to determine whether exercise in the aquatic environment is an effective therapy in the treatment of patients with multiple sclerosis, in terms of clinical symptoms and performance of activities of daily living.

Material and methods
We performed a literature search in major databases such as Cochrane MS Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, CINAHL (Ovid), WOK, PubMed, EBSCO, SCOPUS and Sport Discus to identify relevant studies published between April 2004 and February 2010. We examined reference lists of identified studies. They were also searched abstracts published in proceedings of scientific conferences.

Population
People of all ages and both sexes, diagnosed with MS. Intervention. All types of aquatic therapeutic exercises led by physical therapists.

Comparison
Descriptive observational studies (case series) were included. There were no randomized clinical trials, as had no control group. Different forms of therapy are compared. The collection and data analysis to assess the quality of the trials was performed by a single reviewer.

Outcome Measures: EDSS (Expanded Disability Status Scale), modified Ashworth scale, Test of Oxford, Tinetti test for March, the modified Rivermead Mobility Index, Fatigue Severity Scale (FSS), Functional Measure Scale (FIM), Questionnaire experiences with cycle ergometer test, Aquatics Participation Survey (APS), Satisfaction with Life Scale (SWLS).

Conclusion
No conclusive results were obtained with which to compare the water activity with other forms of treatment, both inside and outside the water, and
recommend this treatment modality. The methodological quality of included studies could not be assessed, so neither could make an estimate of the effectiveness of these groups based on the various symptoms evaluated. The absence of control groups, the small sample size, lack of heterogeneity between studies in the number of subjects, duration of symptoms, the difference in the interventions and results presentation, prevented any comprehensive analysis of them. There were no sufficient evidence to suggest which therapeutic water exercise, and what techniques were recommended for patients with multiple sclerosis, in terms of improving clinical symptoms and the realization of their daily life activities. There is a need for further testing of high methodological quality to justify the use of water exercise therapy in patients with multiple sclerosis.

Key Words: Aquatic Therapy, convenience, evidence-based practice, Multiple Sclerosis, outcomes.

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