Comparing Outcomes and Improvement Predictors between Aquatic and Land-Based Physical Therapy for Patients with Lower Extremity Musculoskeletal Disorders

比較下肢肌肉骨骼障礙的病患接受水中復健運動訓練以及陸地復健運動訓練後功能改善效果和預測因子

戴菀葶(Wan-Ting Tai) ； 江威漢(Wei-Han Chiang) ； 李雪楨(Hsuei-Chen Lee) ； 陳文英(Wen-Yin Chen)

《物理治療》 42卷2期 (2017/06) Pp. 147-148

https://doi.org/10.6215/FJPT.2017.73.O20

摘要

Background: Lower extremity musculoskeletal disorders (LE MSD) could affect functional mobility and quality of life of the patients. Land-based and aquatic physical therapies are widely used for these conditions. Identifying the factors associated with improvement is important for clinicians to decide what treatment is more appropriate to prescribe for their patients. However, current literature contains insufficient information addressing the predictive factors related to outcomes of different physical therapy approaches for LE MSD. Purpose: (1) To compare outcomes between the land-based and aquatic physical therapy for these patients, and (2) To explore factors associated with improvement in patients with LE MSD. Methods: This was a prospective and exploratory study. A total of 204 patients with LE MSD participated. Their demographic, health and illness-related data, pain intensity and duration, score of lower extremity functional (LEFS) status, and numeric pain score were obtained upon first visit. Patients received 4 weeks land-based program (n = 134) or aquatic program (n = 70) and were reassessed. Outcome improvement was determined by fulfilling: perceived improvement (global rating score) ≥ 4 and either pain reduction ≥ 2 or functional improvement ≥ 9. Statistical Analyses: Two-way repeated measures ANOVA was used to compare treatment effects between the two physical therapy programs (p ＜ 0.05). A multivariate stepwise logistic regression analysis was used to identify significant predictors for classifying outcome improvement non-improvement (p ＜ 0.05). Result: Pain and function were significantly improved 4 weeks after receiving in either the land-based or aquatic groups therapy (p ＜ 0.001). Patients being older than 50 years (OR = 3.73, 95% CI = 1.36 ～ 10.17), with pain intensity more than 2/10 (OR = 1.87, 95% CI = 1.43 ～ 2.46), and maintaining physical activity level of 3-5 times/week before therapy (OR = 3.2, 95% CI = 1.01 ～ 10.23) were more likely to improve with the land-based physical therapy; and those having hip or ankle impairments (OR = 0.2, 95% CI = 0.05 ～ 0.91), pain intensity over 2/10 (OR = 1.5, 95% CI = 1.08 ～ 2.08) before therapy were more likely to improve with aquatic physical therapy. Conclusion: Land-based physical therapy is more effective for older patients, higher initial pain level and maintaining physical activity level, while aquatic physical therapy is more effective for having hip or ankle dysfunction and higher initial pain level. Clinical Relevance: This study finding could enhance the efficacy of clinical decision-making in selecting aquatic or land-based intervention for patients with LE MSD.